Gastroenterology Today Summer 2022

Volume 32 No. 2 

Summer 2022 

In this issue 

Xxx 

Xxx 

Xxx 

Anyone for 

Mobile Endoscopy? 

Endoscopy sees increased activity, 

but waiting lists remain challenging 

The recent record surge in the number of NHS 

patients being referred for cancer checks is part of a 

welcome increase in diagnostics activity as the NHS 

looks to refocus on waiting lists post-pandemic.

Find out more at www.alphalabs.co.uk 

Simple Solutions to Support 

Clinical Decision Making 

in Gastroenterology 

Calprotectin 

Testing 

Make more informed clinical decisions 

without waiting for lab results. 

The future for IBD Care: 

■ IBDoc ® Home Tests 

Supporting remote patient 

monitoring and virtual clinics 

■ Quantum Blue ® for Point of Care 

Helps triage patients in clinic 

giving results in a rapid 

time frame (15 minutes) 

Faecal 

Immunochemical 

Testing 

Triage patients within the colorectal 

cancer pathway to better manage 

colonoscopy resources. 

■ Complete customised FIT 

‘Patient Packs’ 

■ Include everything the patient 

requires to take their sample 

safely at home and return 

it to the laboratory. 

For more information, to discuss your requirements or organise 

an evaluation please contact: digestivedx@alphalabs.co.uk 

Supplied by 

g 

H 

999123 

2021.12.31 

Name 

80101274 

Date of Sample 

NAME 

Mr 

Ms 

M / F 

Date of Birth (DD/MM/YYYY) 

HOW to Pl 

/ / 

1. Preparation 

Date of Sampling (DD/MM/YYYY) 

/ / 

l 

Write 

your NAME and Date of Birth on the 

Green Plastic Bag and Device. 

Carefully and slowly twist and pull out the 

Stick Part from Main BODY. 

T: +44 (0)23 8048 3000 

E: sales@alphalabs.co.uk 

W: www.alphalabs.co.uk 

Come and see us at stand A6 

21 - 23 June 2022 | ICC Birmingham

CONTENTS 

CONTENTS 

4 EDITORS COMMENT 

6 FEATURE Gluten-free diet offers an effective option for 

those with IBS to manage their symptoms 

9 FEATURE Magnifying endoscopic findings of early-stage 

poorly differentiated colorectal adenocarcinoma: 

a case report 

Matthew’s Perspective: 

15 FEATURE Postpolypectomy fever in patients with serious 

infection: a report of two cases 

21 NEWS 

28 REPORT The Cost of Opioid-induced constipation (OIC) 

An essential report into the financial and personal 

cost of OIC 

29 COMPANY NEWS 

This issue edited by: 

Hesam Ahmadi Nooredinvand 

c/o Media Publishing Company 

Greenoaks 

Lockhill 

Upper Sapey, Worcester, WR6 6XR 

What approach has 18 Week Support 

taken with regards to building an 

expert insourcing team? 

ADVERTISING & CIRCULATION: 

Media Publishing Company 

Greenoaks, Lockhill 


Tel: 01886 853715 

E: info@mediapublishingcompany.com 

Dr Matthew Banks is the Clinical Director for 18 Week Support Gastroenterology. He believes it starts with recruiting the 

www.MediaPublishingCompany.com 

best clinicians. ‘At 18 Week Support we set the bar very high. We only recruit clinicians whose JAG performance data is well 

above the national standards. In addition, we monitor each clinician’s KPIs while they work with 18 WS. While the JAG data 

is an excellent quality indicator, we now want to go a step beyond that and PUBLISHING monitor the Non-Technical DATES: skills (NTS) of each 

clinician as well. We now know that NTS plays an important role in safe and effective team performance. Therefore, in our 

March, June, September and December. 

quest to develop excellent teams who deliver a world-class service, we must focus on NTS’. 

Tammy and Lisa’s Perspective: 

COPYRIGHT: 

Tammy Kingstree is Lead Nurse for Endoscopy. 

Media Publishing Company 

‘It is extremely important that there are good working relationships within the team. This starts with strong leadership from 

Greenoaks 

our senior nurse coordinators who are trained to manage the patient pathway, manage a team of staff they may not know 

and to deal effectively with any issues which may arise on the day’. Lockhill 


Lisa Phillips is Lead Nurse for Endoscopy. 

‘The team objectives are clear. Excellent patient experience and good patient outcomes. Because the objectives are clear, 

team cohesion and focus are exceptionally good. It therefore shouldn’t matter PUBLISHERS that we are in an unfamiliar STATEMENT: 

endoscopy unit, 

the service should be seamless. If it isn’t, we do not stop until we get it right. The views and opinions expressed in 

this issue are not necessarily those of 

If you have an excellent NHS record and want to help clear NHS waiting list backlogs, reduce RTT waiting times and provide 

the Publisher, the Editors or Media 

high-quality patient care, get in touch by calling on 020 3892 6162 or email Gastro.Recruitment@18weeksupport.com 

Publishing Company. 

COVER STORY 

In this edition, Dr Matthew Banks, Clinical Lead for Gastroenterology at 

18 Week Support, explores what it is like to deliver endoscopy as part of 

a team in a modular endoscopy suite. These mobile units are increasingly 

popular for Trusts looking to secure extra theatre capacity quickly and cost 

effectively. With diagnostic waiting times still at record highs, it is likely that 

many of you will at some point work in such units, and Matthew’s experience 

and insights will hopefully prove helpful. 

Next Issue Autumn 2022 

Subscription Information – Summer 2022 

Gastroenterology Today is a quarterly 

publication currently sent free of charge to 

all senior qualified Gastroenterologists in 

the United Kingdom. It is also available 

by subscription to other interested individuals 

and institutions. 

UK: 

Individuals - £24.00 incl postage 

Commercial Organistations - £48.00 incl postage 

Overseas: 

£72.00 incl Air Mail postage 

We are also able to process your 

subscriptions via most major credit 

cards. Please ask for details. 

Cheques should be made 

payable to MEDIA PUBLISHING. 

Designed in the UK by me&you creative 

GASTROENTEROLOGY TODAY - SUMMER 2022 

3

EDITORS COMMENT 

EDITORS COMMENT 

“A recent large 

multicenter 

study by the 

Sheffield 

Gastroenterology 

group found 

that gluten free 

diet has similar 

efficacy to a 

low FODMAP 

diet which can 

perhaps provide 

a simpler and 

less restrictive 

dietary option in 

some patients 

with IBS.” 

Irritable bowel syndrome is a prevalent functional gastrointestinal disorder accounting 

for approximately a quarter of gastroenterologists’ time in the outpatient clinic. We know 

that diet plays a crucial role in management of these patients however choosing the right 

diet can be challenging. 

One of the most commonly used diets is the low FODMAP diet and although there is 

evidence to suggest many patients with IBS benefit from this, it is quite a restrictive diet 

meaning adherence can be an issue. A recent large multicenter study by the Sheffield 

Gastroenterology group found that gluten free diet has similar efficacy to a low FODMAP 

diet which can perhaps provide a simpler and less restrictive dietary option in some 

patients with IBS. We have an article summarising these findings in this summer issue of 

Gastroenterology Today. Other articles include: 

• Case report highlighting the importance of careful lesion assessment through use of 

magnification and chromoendoscopy to predict histology and hence appropriateness of 

endoscopic resection of a lesion found during endoscopic examination 

• Two cases of post-polypectomy fever, a rare but potentially serious condition with lifethreatening 

complications, highlighting the importance of early recognition and prompt 

antibiotic therapy 

Hesam Ahmadi Nooredinvand, 

St George’s Hospital 


4

Prescribe Entocort ® CR by brand 

instead of prednisolone 

• Rapid induction of remission from 2 weeks with 

Entocort ® CR* 1 

• ~50% fewer corticosteroid-associated side effects 

than prednisolone 2,3 

• Unlike Entocort ® CR, prednisolone increases 

susceptibility to, and severity of, infections †2,4 

• Entocort ® CR is the only controlled-release 

oral budesonide indicated for Crohn’s disease 2 

Help keep your Crohn’s patients out of hospital... 

...and where they want to be 

*Remission was defined as a score of ≤150 on the Crohn’s disease activity index. 

†Entocort ® CR should be used with caution in patients with infections where the use of glucocorticosteroids may have unwanted effects. 2 

ENTOCORT CR 3mg Capsules (budesonide) - Prescribing 

Information 

Please consult the Summary of Product Characteristics (SmPC) for full 

prescribing Information 

Presentation: Hard gelatin capsules for oral administration with an 

opaque, light grey body and an opaque, pink cap marked CIR 3mg in black 

radial print. Contains 3mg budesonide. Indications: Induction of remission 

in patients with mild to moderate Crohn’s disease affecting the ileum and/or 

the ascending colon. Induction of remission in patients with active 

microscopic colitis. Maintenance of remission in patients with microscopic 

colitis. Dosage and administration: Active Crohn’s disease (Adults): 9mg 

once daily in the morning for up to eight weeks. Full effect achieved in 2-4 

weeks. When treatment is to be discontinued, dose should normally be 

reduced in final 2-4 weeks. Active microscopic colitis (Adults): 9mg once 

daily in the morning. Maintenance of microscopic colitis (Adults): 6mg once 

daily in the morning, or the lowest effective dose. Paediatric population: Not 

recommended. Older people: No special dose adjustment recommended. 

Swallow whole with water. Do not chew. Contraindications: 

Hypersensitivity to the active substance or any of the excipients. Warnings 

and Precautions: Side effects typical of corticosteroids may occur. Visual 

disturbances may occur. If a patient presents with symptoms such as 

blurred vision or other visual disturbances they should be considered for 

referral to an ophthalmologist for evaluation of the possible causes. 

Systemic effects may include glaucoma and when prescribed at high doses 

for prolonged periods, Cushing’s syndrome, adrenal suppression, growth 

retardation, decreased bone mineral density and cataract. Caution in 

patients with infection, hypertension, diabetes mellitus, osteoporosis, 

peptic ulcer, glaucoma or cataracts or with a family history of diabetes or 

glaucoma. Particular care in patients with existing or previous history of 

severe affective disorders in them or their first degree relatives. Caution 

when transferring from glucocorticoid of high systemic effect to Entocort 

CR. Chicken pox and measles may have a more serious course in patients 

on oral steroids. They may also suppress the HPA axis and reduce the stress 

response. Reduced liver function may increase systemic exposure. When 

treatment is discontinued, reduce dose over last 2-4 weeks. Concomitant 

use of CYP3A inhibitors, such as ketoconazole and cobicistat-containing 

products, is expected to increase the risk of systemic side effects and 

should be avoided unless the benefits outweigh the risks. Excessive 

grapefruit juice may increase systemic exposure and should be avoided. 

Patients with fructose intolerance, glucose-galactose malabsorption or 

sucrose-isomaltase insufficiency should not take Entocort CR. Monitor 

height of children who use prolonged glucocorticoid therapy for risk of 

growth suppression. Interactions: Concomitant colestyramine may 

reduce Entocort CR uptake. Concomitant oestrogen and contraceptive 

steroids may increase effects. CYP3A4 inhibitors may increase systemic 

exposure. CYP3A4 inducers may reduce systemic exposure. May cause low 

values in ACTH stimulation test. Fertility, pregnancy and lactation: Only 

to be used during pregnancy when the potential benefits to the mother 

outweigh the risks for the foetus. May be used during breast feeding. 

Adverse reactions: Common: Cushingoid features, hypokalaemia, 

behavioural changes such as nervousness, insomnia, mood swings and 

depression, palpitations, dyspepsia, skin reactions (urticaria, exanthema), 

muscle cramps, menstrual disorders. Uncommon: anxiety, tremor, 

psychomotor hyperactivity. Rare: aggression, glaucoma, cataract, blurred 

vision, ecchymosis. Very rare: Anaphylactic reaction, growth retardation. 

Prescribers should consult the summary of product characteristics in 

relation to other adverse reactions. Marketing Authorisation Numbers, 

Package Quantities and basic NHS price: PL 36633/0006. Packs of 50 

capsules: £37.53. Packs of 100 capsules: £75.05. Legal category: POM. 

Marketing Authorisation Holder: Tillotts Pharma UK Ltd, The Stables, 

Wellingore Hall, Wellingore, Lincoln, LN5 0HX. Date of preparation of PI: 

February 2020 

Adverse events should be reported. 

Reporting forms and information can be 

found at https://yellowcard.mhra.gov.uk. 

Adverse events should also be reported to 

Tillotts Pharma UK Ltd. Tel: 01522 813500. 

References: 1. Campieri M et al. Gut 1997; 41: 209–214. 2. Entocort ® 

CR 3 mg capsules – Summary of Product Characteristics. 3. Rutgeerts 

P et al. N Engl J Med 1994; 331: 842–845. 4. Prednisolone 5 mg tablets 

– Summary of Product Characteristics. 

Date of preparation: August 2021. PU-00572.

FEATURE 

GLUTEN-FREE DIET OFFERS AN 

EFFECTIVE OPTION FOR THOSE WITH 

IBS TO MANAGE THEIR SYMPTOMS 

New research from the Sheffield Gastroenterology group has 

found that a gluten-free diet offers an equally effective dietary 

treatment option for those with irritable bowel syndrome (IBS) 

looking to manage their symptoms, alongside first and secondline 

dietary advice currently recommended. 

In the largest multicentre study of its kind, researchers investigated the 

long-term use of the low-FODMAP diet, the recommended second-line 

dietary treatment option, amongst IBS patients originally advised on the 

diet by dietitians based in 5 key UK hospitals 1 . The study found that the 

low FODMAP diet had longevity and continued success for the majority 

of patients with 76% continuing to follow a personalised form of the diet 

up to 8 years later. 

A key insight from the study was that 68% of these patients who 

reported to be following a personalised low FODMAP diet in the long 

term, regularly purchased specialist gluten and wheat-free products to 

help manage their symptoms. This led researchers to question whether 

the gluten-free diet may in fact be a simpler route to the same benefit 

and whether the gluten-free diet is in fact the crux of the ‘personalised’ 

low FODMAP diet, which has the potential to benefit a large percentage 

of IBS sufferers. This ‘FODMAP light’ or ‘FODMAP gentle’ approach 

could provide an alternative ‘bottom up’ management approach for IBS 

alongside the existing ‘top down’ low FODMAP diet (see fig. 1). 

IBS (see fig. 2). Whilst traditional advice was found to be more patient 

friendly, and so should remain the first-line dietary treatment option, the 

low FODMAP diet and gluten-free diet should be considered as equally 

effective second-line alternatives, based on patient preference and 

specialist opinion. These findings are of particular relevance, given that 

an earlier piece of research from the same team demonstrated inequity 

in GI dietetic service provision across England, with regional differences 

in the level of provision and extent of specialist care and insufficient time 

for clinic appointments 3 . Given these findings, there is an urgent need to 

consider less complex dietary interventions for common conditions such 

as IBS in order to maximise efficiency and standards in patient care. 

Dr Imran Aziz, Consultant 

Gastroenterologist at the Royal 

Hallamshire Hospital, Sheffield 

commented: 

“Diet appears to play a pivotal 

role in symptom generation in IBS 

patients. Over the last decade 

there has been a substantial 

increase in interest in the role of 

dietary therapies in IBS, including 

a gluten-free diet. This latest 

research shows that a glutenfree 

has a similar level of efficacy 

Fig. 2 

to traditional dietary and low 

FODMAP dietary advice and so deserves a seat at the table. It is an 

important step in providing IBS patients with choice, helping them to find 

relief from their symptoms in the simplest, most effective way for them.” 


Fig. 1 

A follow-up randomised trial, led by the Sheffield team involved a headto-head 

investigation looking at the best treatment options for patients 

with IBS in real world conditions 2 . It compared traditional (first-line) 

dietary advice, a low FODMAP diet and a gluten-free diet. 

The key finding from the study was that all three diets were equally 

effective in managing symptoms for patients with non-constipated 

Katie Kennedy, Company Dietitian for gluten-free food manufacturer Dr 

Schär who helped to fund this research, added: 

“Dr Schär were delighted to support Sheffield to conduct this research, the 

first study of it’s kind to compare all three major dietary interventions for 

IBS. The results will empower dietitians to suggest the most appropriate 

dietary treatment options for their IBS patients in a joint decision-making 

process. This study proves that, if advised on and followed correctly, 

traditional dietary advice can help the majority of IBS sufferers to find relief 

from their symptoms, without the need for more complex and costly dietary 

interventions. If traditional dietary advice fails, then there are further, equally 

effective options available to patients, including a gluten-free diet”. 

Further research is underway to build on these findings and provide 

further impetus for a medical consensus and future change in national 

guidance on IBS. 

6 

References 

1. Rej, A, Shaw C, Buckle R et al. The low FODMAP diet for IBS: A multicentre UK study assessing long-term followup. 

Dig Liver Dis 2021 Nov;53(11):1404-1411. Doi: 10.1016/j.dld.2021.05.004.Epub 2021 Jun 1 

2. Rej A, Sanders DS, Shaw CC, et al. Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable 

Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet and the Gluten-Free 

Diet. Clin Gastroenterol Hepatol. 2022 Feb 28: S1542-3565 (22) 00202-6. doi: 10.1016/j.cgh.2022.02.045. 

Online ahead of print 

3. Rej A, Buckle RL, Shaw CC, et al. National survey evaluating the provision of gastroenterology dietetic services in 

England. Frontline Gastroenterology 2020:flgastro-2020-101493.

FEATURE 

The Perfect Match... 

“Several studies have shown that the use of multiple 

ERCP tissue sampling techniques in combination 

can improve the cancer detection rate.” 1 

The Histoguide wireguided 

forceps joins the 

clinically proven Infinity ® 

ERCP sampling device. 

Pairing the two devices for 

a two-tiered, multi-modality 

sampling approach may 

help improve diagnostic 

capabilities and lead to 

increased sensitivity during 

ERCP procedures. 1 

Histoguide 

wire-guided 

forceps 

Infinity ERCP 

sampling 

device 

For more information on our ERCP 

portfolio, visit diagmed.healthcare 

Tel: +44 (0) 1845 526660 | Email: info@diagmed.co.uk 

1. Korc, P. and Sherman, S. “ERCP tissue sampling.” 

GIE Journal 2016; 84 (4)L 557-571. 

a STERIS company 


7


NHS trusts with: 

2WW Urgent referrals 

Routine referrals 

ADVERTORIAL FEATURE 

Surveillance cases 

Bowel cancer screening services 

ANYONE FOR MOBILE ENDOSCOPY? 

NHS Facility NHS Staff NHS 

Enhanced sedation (Propofol) lists 

Additionally, we can support Direct Access 

and Rapid Access endoscopy referrals by 

working with the local clinical leads to agree 

strong governance for the management of 

these patients. 

Endoscopy sees increased activity, but waiting lists remain challenging 

The recent record surge in the number of NHS patients being referred 

for cancer checks is part of a welcome increase in diagnostics activity as 

the NHS looks to refocus on waiting lists post-pandemic. Other areas of 

diagnostics have also seen an uptick. In colonoscopy and gastroscopy, 

the latest available statistics (February 2022) show that waiting lists have 

fallen by 0.9% and 11.9% respectively compared to February 2021. 

However, the overall diagnostics picture remains challenging with more 

than 1.5 million patients still waiting longer than the 6-week wait for the full 

range of key diagnostic tests. Despite more tests being undertaken across 

gastroenterology, some 63,599 patients are still waiting for colonoscopy 

and 64,700 are still waiting for gastroscopy. Recent analysis by Macmillan 

suggests there have been nearly 50,000 fewer cancer diagnoses due to 

Covid-related delays, and the NHS will have to work at 110% capacity to 

clear the backlog, taking an estimated 18 months to catch up on missed 

cancer diagnoses and 15 months for cancer treatment. 

Criteria & Quality 

We select Endoscopists with an endoscopy 

orientated career path and performance 

measures above the national average. JAG 

audit data is constantly monitored to ensure 

ongoing quality. Furthermore, we have a 

clinical governance department that is crucial 

to maintaining quality and safety but also 

provides support to both Endoscopists and 

the units within which we work. 

Trusts shift to on-site mobile and modular theatre suites to better 

focus on waiting list reduction 

The NHS is of course already engaged in this challenge and is rolling out 

a broader mix of diagnostic services and facilities, including one-stop 

shops for tests as well as symptom hotlines. 

A particularly successful initiative however has been Trusts’ embracing 

of mobile and modular theatre units, usually located on-site, which have 

helped them focus on reducing waiting lists while keeping procedures 

separated from main hospital buildings, especially important given the 

need for safe Covid and general infection control. 

We provide tailored solutions to manage 

capacity from straight forward supply of staff 

to a team based managed solution to a full 

patient pathway including pathology review. 

Here at 18 Week Support, the UK’s largest clinical insourcing provider, 

we have provided specialist endoscopy teams for a number of Trusts 

where we staff and operate mobile theatre units they have contracted 

from specialist providers such as Vanguard Healthcare Solutions. 

We have assisted over 55 Trusts around the country, carrying out the full 

range of endoscopy procedures either in-house or in mobile theatres, 

both during and after Covid-19. Indeed Trusts have been so pleased 

with the mobile and modular theatre suites concept that many are now 

including them in their planning for reducing waiting lists, adding new 

theatre capacity quickly and cost-efficiently. 

Our commitment to improving the 

NHS experience 

Like the NHS Trusts we work with, patient 

care is at the centre of everything we do. By 

using any spare weekend capacity within a 

Trust, the 18 Week Support insourcing teams 

are able to see a high volume of patients 

in a short space of time, in the familiar 

surrounding of the NHS Trust. 

The experience of endoscopy delivery in modular mobile suites 

But what is the actual experience like for endoscopists to work in a 

stand-alone ‘cold site’? 

Dr Matthew Banks, Clinical Lead for 18 Week Support Gastroenterology, 

believes that although the experience is obviously new and has some 

specific challenges, adaptation to the new working environment can 

be rapid and relatively straightforward given 18 Week Support’s teams 

are mainly drawn from existing or recently retired NHS Consultants and 

nurses looking for extra shifts or to work part-time for a period. 

“Endoscoping in a mobile or semi-permanent endoscopy suite requires 

a degree of flexibility and adaptability. One needs to take time getting 

familiar with the unit, layout, equipment and IT. Once you have your 

An ethical company 

We’re Matthew. an ethical and transparent company 

that’s financially accountable and financially 

responsible. We’re committed to the NHS 

8 and the delivery of high-quality care, and to 

helping Trusts reduce RTT waiting times. 

awareness, it is very much like scoping in any endoscopy unit”, said 

Staff do however need to be aware of the limitations. Matthew added, 

“Often you are isolated, with no, or very limited clinical back up and 

this dictates the level of complexity of the patients being endoscoped. 

Complex therapeutics and high-risk patients (ASA grade III/IV) are 

usually avoided, and the bulk of the work is straightforward diagnostic 

endoscopy”. 

Those working in insourcing teams like 18 Week Support will often find 

themselves working with different nurses through the course of a week, 

or over a longer period of time. Leadership, patience and understanding 

is needed to ensure the quality delivered is constant and of a high level. 

In addition, each unit team will typically have a Nurse in Charge (NIC) 

who runs the day and the lists. For consultants, focussing on their 

role as the endoscopist is key, and working as a team is essential in 

Happy patient 

ensuring all patients are managed appropriately. “Whilst in the room, 

the endoscopist needs to show leadership, but they also need to 

understand that someone else is actually in charge of the unit, and this 

can be a challenge for many consultant endoscopists”, said Matthew. 

Who we’re looking for 

Another “working-life” difference arises not from working in a mobile unit 

per We se, are but interested from working for in a third-party meeting organisation with Consultant 

within NHS 

Trust framework. This relationship necessarily means that patients are 

Gastroenterologists, senior nurses and clinical 

not followed up by the endoscopist, histology is often not available to 

review nurse after specialists the event and sometimes throughout clinical the information UK. can be quite 

limited. Moreover, because of the COVID pandemic, the endoscopist 

is often the first ‘face to face’ consultation the patient has had in two 

years. The pre-procedure process is therefore key to understanding the 

Our remuneration package is second to 

patients concerns and ensuring the correct procedure is completed - 

or occasionally no procedure performed at all. 

none and is per session rather than per case 

which allows our teams to work in a safe and 

The quality and performance of the 18 Week Support teams is not 

only reflected in its JAG data but also across its patient satisfaction 

scores calm which environment’ 

are exemplary across the UK. Recruiting high-performing 

endoscopists that are passionate about their work helps ensure 

18 Week Support’s JAG safety and quality data is above the national 

average as documented in the national endoscopy database. 

About you 

Clinical team 

processes 

For those looking for additional career experience and exposure from 

working in an insourcing endoscopy team, Matthew advises that 

“flexibility, 

If you 

adaptability, 

have an 

leadership 

excellent 

and good 

NHS 

clinical 

record 

knowledge 

and 

and skills 

- in addition sound technical skills - are essential in working in this 

want to help clear NHS waiting list 

environment”. 

backlogs, reduce RTT waiting times and 

If provide you have an high-quality excellent NHS record patient and want care, to help clear get waiting in list 

backlogs, reduce RTT waiting times and provide high-quality patient 

care, touch please by apply calling with us on here: 020 3966 9081 or email 

https://bit.ly/18-week-support-application-37. 

recruitment@18weeksupport.com 

Alternatively, please contact us on tel. 0203 869 8790 or email us at 

recruitment.team@18weeksupport.com. If you are procurer of 18 

Week Support services, please contact busdev@18weeksupport.com. 

18 Week Support 

www.18weeksupport.com 

Dr Matthew Matthew Banks Banks 

Clinical Lead for Gastroenterology 

18 Week Support 

London 3rd Floor, 19-21 Great Tower Street, London EC3R 5AR 

Birmingham Unit 25, Lichfield Business Village, The Friary WS13 6QG 

Follow us: 18-week-support 18 Week Support @18WeekSupport 

GASTROENTEROLOGY TODAY - SPRING 2019

FEATURE 

MAGNIFYING ENDOSCOPIC FINDINGS OF EARLY- 

STAGE POORLY DIFFERENTIATED COLORECTAL 

ADENOCARCINOMA: A CASE REPORT 

Haiyan Li 1 , Yao Liu 2 and Jianhong Zhu 1* 

Li et al. BMC Gastroenterology (2022) 22:148 https://doi.org/10.1186/s12876-022-02209-w 

Abstract 

Case presentation 

Background: Colorectal poorly differentiated adenocarcinoma is 

rarely founded, especially in early-stage. Endoscopic features of early 

poorly differentiated colorectal cancer in magnifying endoscopy and 

chromoendoscopy haven’t been clarified. 

Case presentation: A 49-year-old man was referred to our hospital 

for endoscopic treatment of a lateral spread tumor located in the 

rectum. We performed pre-resection endoscopic examination for the 

patient. In magnifying endoscopy with crystal violet staining, the lesion 

showed irregular microvessels and turned out to be poorly stained 

with predominantly non-structural pit pattern and a few roundish pits 

scattered on the surface. The histology revealed a poorly differentiated 

adenocarcinoma of the rectum invading the deep submucosal layer with 

negative lymphovascular invasion. 

Conclusions: In this case report, we presented a case of poorly 

differentiated colorectal adenocarcinoma detected at an early stage, 

showing interesting endoscopic findings in magnifying endoscopy with 

crystal violet staining. 

Keywords: Colorectal poorly differentiated adenocarcinoma, Magnifying 

endoscopy, Chromoendoscopy, De-novo colorectal cancer, Case report 

Background 

Colorectal poorly differentiated adenocarcinoma is rarely 

founded, especially in early-stage. Most cases are detected at an 

advanced stage. In contrast to differentiated adenocarcinoma, 

poorly differentiated adenocarcinoma often correlates with more 

aggressive biological behavior and is defined to be out-ofindication 

for endoscopic resection even in early-stage. Thus, the 

endoscopic diagnosis of poorly differentiated adenocarcinoma is 

important. Several endoscopic diagnostic classifications, including 

Kudo’s pit pattern classification, have been proposed and proved 

to distinguish colorectal cancer from non-neoplastic lesion or 

adenomas, as well as predict the depth of invasion in colorectal 

cancer. These diagnostic methods mostly focus on adenomas 

or differentiated adenocarcinomas. Perhaps due to its rarity, 

endoscopic features of early poorly differentiated colorectal cancer 

in magnifying endoscopy and chromoendoscopy haven’t been 

clarified. We here present a case of poorly differentiated colorectal 

cancer in the early-stage, showing specific findings in magnifying 

endoscopy with crystal violet staining. 

A 49-year-old man was referred to our hospital for endoscopic 

therapy of a lateral spread tumor (LST) in the rectum in December 

2019. At the previous hospital, biopsy histology showed high-grade 

intraepithelial neoplasia (HGIN). He had a three-week history of 

intermittent hematochezia. Family history for colorectal malignancy was 

negative. Physical examinations and routine laboratory tests revealed 

no abnormalities. Before resection, the patient underwent a magnifying 

chromoendoscopy examination. White-light endoscopy showed a 

superficially elevated lesion with slight depression in the central part, 

together with a reddish scar due to previous biopsy (Fig. 1A). The 

proximal part of the lesion presented with dense irregular microvessels 

in NBI mode (Fig. 1B). In magnifying endoscopy combined with 0.05% 

crystal violet staining, the proximal part showed irregular microvessels 

and turned out to be poorly stained with predominantly non-structural 

pit pattern, while the background mucosa showed regular Type-I pit 

patterns according to the Kudo’s classification (Fig. 1C). The distal part 

showed poorly stained with predominantly non-structural pit pattern, 

as well as a few small roundish pits scattered over the surface (Fig. 

1D). The demarcation line between the lesion and normal mucosa was 

clearly visible. The whole lesion was lifted after submucosal injection 

and then resected completely (Fig. 2A) through endoscopic submucosal 

dissection (ESD). Histology of the resected sample showed poorly 

differentiated adenocarcinoma invading into deep submucosal layer, with 

negative lymphovascular invasion and negative resection margin (Fig. 

2B–D). P53 Immunohistochemistry staining showed complete absence 

in the cancerous area, which was predictive of TP53 truncated mutation. 

The MMR and APC genes showed intact expression, and ß-catenin was 

expressed in the cellular membrane and cytoplasm (Fig. 3). KRAS gene 

mutation was conducted through Polymerase Chain Reaction (PCR) 

and also showed negative results. The patient then underwent additional 

surgery with lymph node dissection and final histology showed no 

residual tumor and no lymph node involvement. Follow-up surveillance 

colonoscopy and contrast enhanced computed tomography were 

performed for the patient in both the first year and second year after 

surgery. Neither local recurrence nor distant metastasis was detected 

over a two-year follow-up period. 

Discussion and conclusions 

Endoscopic resection is indicated for Tis or T1 tumors and 

pathological findings of unfavorable features including poorly 

differentiation and deep submucosal infiltration are considered to be 

non-curative [1]. Magnifying endoscopy with chemical dye staining 

is usually conducted for pre-resection assessment in these cases. 


*Correspondence: zhujianhong1980@sina.com 

1 

Department of Gastroentorology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China 

2 

Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China. 

©The Author(s) 2022 

9

FEATURE 

Kudo’s pit pattern classification, which shows the relationship 

between pit patterns and histology, is accurate in differentiating 

neoplastic and non-neoplastic lesions and predicting tumor invasion 

depth. However, there has been no endoscopic diagnosing criteria 

in determining histologic type and tumor degree of differentiation 

for colorectal cancers. Reviewing the literature, we found a few 

case reports clarifying the endoscopic features of early-stage 

signet ring cell carcinoma in the colorectum [2,3,4]. To the best of 

our knowledge, there have been no reports on the magnifying nor 

the chromoendoscopic findings of poorly differentiated colorectal 

adenocarcinoma. 

Ohnita et al. [2] reported a primary signet ring cell carcinoma 

detected at an early stage. As they reported, the margin of the 

lesion showed IIIL and V I 

pit patterns, while the central part of the 

lesion showed V I 

pit pattern and dense mucus. Similar findings 

have been reported by Fu et al. [3]. As they explained, signet ring 

cells preferred to produce mucus so such lesions were difficult 

to stain and showed avascular areas. However, there was no 

obvious mucus in our case and the whole lesion was also difficult 

to stain using either indigo carmine or crystal violet. In our case, 

the histology revealed a large number of tumor cells overgrowing 

and loss of normal surface epithelium and crypt-like structure 

in the mucosal layer. These findings may explain why the lesion 

was poorly stained. In some histologic sections we observed a 

few normal glandular ducts surrounded by tumors cells (Fig. 2D), 

which was consistent with the scattered roundish pits, i.e., Type-I 

pit patterns in magnifying endoscopy. Minamide et al. [4] reported 

similar findings in colorectal signet ring cell carcinoma but the lesion 

was residual after cold snare polypectomy and the diagnosing 

information may be not adequate. In Kudo’s classification, Type V N 

pit-pattern refers to loss or decrease of pits with an amorphous 

structure and indicates invasive submucosal colorectal cancer. 

Usually, Type V N 

pit-pattern co-exists with Vi pit-pattern or scratch 

sign. The lesion in our case presented poorly stained feature with 

predominately non-structural pit pattern and a few roundish pits 

scattered on the surface. No obvious Vi pit-pattern or scratch sign 

was found. These features were different from those of typical Type 

V N 

pit-pattern in Kudo’s classification. We confused at the failing 

to stain the lesion in the beginning and we repeated several times 

and the outcomes turned out to be the same. Besides the poorly 

stained feature, the proximal part of the lesion showed irregular 

microvessels similar to corkscrew vessels which indicated poorly 

differentiated cancer in the stomach. 


Fig. 1 A White light endoscopy revealed a lateral spread tumor in the rectum. B In near focus NBI mode, the proximal part of the lesion presented 

with dense irregular microvessels. C In magnifying endoscopy combined with 0.05% crystal violet staining, the proximal part of the lesion showed 

poorly stained with predominantly non-structural pit pattern, while the background mucosa showed regular Type-I pit patterns according to the 

Kudo’s classification. The demarcation line was clearly visible (white dotted line). D In magnifying endoscopy combined with 0.05% crystal violet 

staining, the distal part showed poorly stained with predominantly non-structural pit pattern and a few roundish pits (black arrow) scattered over 

the surface 

10

FEATURE 

Fig. 2 A The lesion was en bloc resected. B The specimen was sectioned at 2 mm intervals. C Histology showed poorly differentiated colorectal 

cancer with partial submucosal infiltration (black arrow). Stain: hematoxylin and eosin. D In some sections, histology showed a few normal glandular 

ducts (black arrow) surrounded by tumors cells, which is corresponding to the endoscopic feature, i.e., small roundish pits scattered over the surface 

This was the first time we encountered with early poorly 

differentiated colorectal cancer and due to the lack of adequate 

knowledge, we initially performed endoscopic submucosal 

dissection for the patient. Non-curative endoscopic treatment 

resulted in increases in time and cost and decreased patient’s 

satisfaction. From our case, we suppose that poorly stained 

features with predominantly non-structural pit pattern in magnifying 

endoscopy with crystal violet staining may be related to poorly 

differentiation and thus be inappropriate for endoscopic resection. 

More researches are needed to make a definite conclusion. 


11

FEATURE 


Fig. 3 Immunohistochemistry staining of the lesion 

At the same time, we also analyzed the molecular features of the 

lesion. Colorectal cancers are heterogenous at the genetic level and 

develop via accumulation of genetic molecular alterations, in which 

APC, KRAS, TP53 mutations are mostly founded. Several pathways 

have been proposed for the development and progression of colorectal 

cancer, including the widely accepted adenoma-carcinoma sequence, 

the serrated neoplasia pathway, and de-novo carcinogenesis [5]. 

By definition, de-novo lesions are characterized by the lack of any 

adenomatous remnant. In our case, the lesion presented with 

nonpolypoid growth pattern and no adenomatous remnant was founded. 

12

FEATURE 

Immunohistochemical and molecular analysis of the lesion implied p53 

mutation, without any of APC, ß-catenin, or KRAS mutation. Thus, we 

suppose that the cancerous lesion in our case is associated with p53 

mutation, in accordance with molecular changes of de-novo colorectal 

cancers. 

of Pathology, The Second Affiliated Hospital of Soochow University, 

Suzhou, Jiangsu Province, China. 

Received: 6 August 2021 Accepted: 12 March 2022 

Published online: 28 March 2022 

Availability of data and materials 

All data generated or analysed during this study are included in this 

published article. 

Abbreviations 

LST: Lateral spread tumor; HGIN: High-grade intraepithelial neoplasia; 

NBI: Narrow band imaging; ESD: Endoscopic submucosal dissection; 

P53: Protein 53; TP53: Tumor protein 53; MMR: Mismatch repair 

proteins; MSH2: MutS homolog 2; MSH6: MutS homolog 6; MLH1: 

MutL homolog 1; PMS2: Postmeiotic segregation increased 2; APC: 

Adenomatous polyposis coli; KRAS: Kirsten rat sarcoma viral oncogene 

homolog; PCR: Polymerase chain reaction. 

Acknowledgements 

Not applicable. 

Authors’ contributions 

HL conducted this report and prepared the manuscript. JZ performed 

the colonoscopy and provided the endoscopic images. YL performed 

the histological examination and provided the histology images. All 

authors read and approved the final manuscript. 

References 

1. Shinagawa T, Tanaka T, Nozawa H, et al. Comparison of the 

guidelines for colorectal cancer in Japan, the USA and Europe. Ann 

Gastroenterol Surg. 2017;2(1):6–12. 

2. Ohnita K, Isomoto H, Akashi T, et al. Early stage signet ring cell 

carcinoma of the colon examined by magnifying endoscopy with 

narrow-band imaging: a case report. BMC Gastroenterol. 2015;15:86. 

3. Fu KI, Sano Y, Kato S, et al. Primary signet-ring cell carcinoma of the 

colon at early stage: a case report and a review of the literature. World 

J Gastroenterol. 2006;12:3446–9. 

4. Minamide T, Shinmura K, Ikematsu H, et al. Early-stage primary signet 

ring cell carcinoma of the colon with magnifying endoscopic findings. 

Gastrointest Endosc. 2019;90:529–31. 

5. Papagiorgis PC, Zizi AE, Tseleni S, et al. Clinicopathological differences 

of colorectal cancers according to tumor origin: identification of possibly 

de novo lesions. Biomed Rep. 2013;1:97–104. 

Publisher’s Note 

Springer Nature remains neutral with regard to jurisdictional claims in 

published maps and institutional affiliations. 

ScheBo_GastroToday 29/04/2022 

Funding 

This work was supported by the Doctoral Program Foundation of 

the Second Affiliated Hospital of Soochow University (Grant No. 

SDFEYJBS2102), the Scientific Research Foundation of the Second 

Affiliated Hospital of Soochow University (Grant No. SDFEYQN1811), 

and the discipline construction and support project of the Second 

Affiliated Hospital of Soochow University (Grant No. XKTJ-JD202006). 

Funding enabled immunohistochemical and genetic analysis of the 

resected sample. The funder did not influence the collection and analysis 

of data, the decision to publish and the writing of the manuscript. 


All data generated or analysed during this study are included in this 

published article. 

Declarations 

Ethics approval and consent to participate 


Consent for publication 

Written informed consent was obtained from the patient for publication 

of this case report and any accompanying images. 

Competing interests 

The authors declare that they have no competing interests. 

Author details 

1 

Department of Gastroentorology, The Second Affiliated Hospital of 


Soochow University, Suzhou, Jiangsu Province, China. 2 Department 

13

Elective Services delivering Insourcing solutions to NHS Trusts 

Elective Services commenced insourcing services for NHS Trusts to help with the ever-increasing 

Endoscopy & Gastroenterology capacity demand. We provide highly experienced substantive NHS 

Consultants for clinics as well as full Endoscopy teams (comprising JAG KPI compliant Consultants, 

highly qualified Coordinators, nurses, HCAs, decontamination staff, receptionist & booking staff). 

We are able to provide seven-day NHS services and our endoscopy sessions include diagnostic 

gastroscopies, flexible sigmoidoscopies, colonoscopies as well as advanced endoscopy including 

bowel cancer screening, ERCP and EUS. 

We manage routine, planned/surveillance as well as urgent and target/two week referrals, 

working with NHS Trusts’ to achieve DM01 requirements, JAG accreditation and 18 week RTT. 

Why choose to work with Elective Services? 

• Expertise in Insourcing of clinical services 

• Services managed by Gastroenterologists from world class centres of excellence & experienced 

managers dedicated to each project 

• Offering full end to end pathways with emphasis on continuity of care 

• Teams expertly led by our Medical Director, Endoscopy Co-Directors & Senior nurse Co-ordinators 

• Feedback from patients and trusts is consistently positive, reflecting the highest quality, efficiency and 

dedication of our teams 

• Teams can be mobilised within 2 weeks for both short and long term support 

Endoscopy Service Manager Feedback 

"It is so great to have such positive feedback from our patients for you all and we feel privileged to be 

working with you all. I also took the opportunity to feedback to the CQC last evening about our successful 

partnership.’’ 

Endoscopy Service Manager 

What do some of our Endoscopy Directors say? 

“We recognise the importance of a patient-centered gastroenterology and endoscopy care. 

Having brought together our most experienced specialists and supporting staff, we are able to offer 

a seamless management pathway communicated clearly & candidly to all our patients & the Trusts we serve. 

It’s a privilege to serve our NHS by providing high quality care coupled with efficiency.’’ 

Dr Akeel Alisa MD FRCP 

Medical Director and Gastroenterology & Endoscopy lead 


“Our patients can rest assured they will receive the best care with our dedicated and highly experienced 

efficient staff. We are proud of being passionate in serving our patients and setting high standards of 

personalised care.” 

Adriana Ioan 

Director of Nursing & Endoscopy Coordinators Lead 

14 

Tel No: 0203 771 811 8 

Email: endoscopy@electiveuk.com 

Web: http://www.electiveuk.com 

For registrations call Zack: 

Direct: 07926 484828 

Email: zack@electiveuk.com

FEATURE 

POSTPOLYPECTOMY FEVER IN 

PATIENTS WITH SERIOUS INFECTION: 

A REPORT OF TWO CASES 

Wang Jing 1† , Li Qinghua 1† and Yang Zhiwen 2* 

Jing et al. BMC Gastroenterology (2022) 22:156 https://doi.org/10.1186/s12876-022-02218-9 

Abstract 

Background 

Postpolypectomy fever (PPF) is a rare complication in patients after 

colonoscopy. Because of the absence of evidence of microperforation 

and abdominal tenderness, patients with PPF usually present mild 

clinical symptoms with a good prognosis. 


In this study, all patients who underwent colonoscopic examination in our 

hospital between January 2019 and December 2019 were enrolled. Of 

these, two patients developed PPF after polypectomy, exhibiting serious 

infection without definitive fever foci. One patient experienced rapidly 

aggravated type 1 respiratory failure and abnormal hepatic function, which 

were attributed to colonoscopy-associated infection. After active antibiotic 

therapy, both patients were discharged without any complications. 

Conclusions 

In summary, our study provides novel insights into patients with PPF 

who develop serious infections with life-threatening complications. 

Keywords 

Postpolypectomy fever, Serious infection, Diagnose, Therapy, Patient 

Background 

overlooked in clinical practice, owing to the absence of typical peritoneal 

irritation and definitive fever foci. Thus, our report should aid in timely 

diagnosis and appropriate therapy for patients with PPF. 


Case selection, procedures, and definitions 

In 2019, 12,000 patients underwent colonoscopic examination in our 

hospital, and approximately 2000 patients with gastrointestinal polyps 

received painless endoscopic treatment. These cases of colonoscopies 

were performed in the outpatient and inpatient setting. All colonoscopies 

were elective, not urgent. Patients who received polypectomy were 

admitted to the hospital for about 2–3 days. Two patients after 

colonoscopy met the inclusion criteria with a high fever up to 39.0 °C in 

1–2 h, and the leukocytes, C-reactive protein (CRP) and procalcitonin 

(PCT) increased significantly with signs of infection [5,6,7]. They were a 

health state at admission, without any signs of fever, abdominal pain, 

cough, frequent urination, infection or other discomfort. The results 

of routine analyses of the blood, urine and feces were normal, and no 

signs of infection were observed on chest ` abdominal CT. The patients 

developed serious infections after polypectomy during hospitalization. 

Physical and radiographic examination did not show evidence of 

perforation, hemorrhage, abdominal tenderness or localized peritoneal 

inflammation. No evidence of other explainable fever foci other than 

colonoscopic polypectomy was identified. 

Colonoscopy is widely used in clinical practice, although serious 

complications may result from colonoscopic polypectomy [1, 2]. These 

serious complications are inherent to the procedure and occur at low 

incidence during colonoscopy. Hemorrhage and perforation, the most 

feared complications, occur in ≤ 0.3% and 0.3–0.6% [3, 4], respectively. 

Postpolypectomy electrocoagulation syndrome (PPCS), a rare 

complication, ranges from 0.07 to 1.0% [3, 4]. 

Here, we report the cases of two patients who developed PPF after 

colonoscopy, and experienced new-onset fever without localized 

peritoneal signs or definitive fever foci. Aggravated serious infectious 

symptoms were present with a high fever up to 39.0 °C in 1–2 h after 

operation, and the patients received further therapy in the general 

intensive care unit (GICU). As reported previously, patients with PPF 

generally present mild clinical symptoms with good prognosis. To our 

knowledge, this is the first report of patients with PPF developing serious 

infections with life-threatening complications. Additionally, PPF is easily 

Patients with postpolypectomy bleeding, microperforation, abdominal 

tenderness, localized peritoneal inflammation and infection associated 

with definitive fever foci other than colonoscopic polypectomy were 

excluded. 

All colonoscopic polypectomies were performed with standard 

colonoscopes (CF-H260AL; Olympus Optical Co., Ltd., Tokyo, Japan). 

Patients were slowly intravenously injected with propofol. Patients who 

received polypectomy operation were admitted to the hospital for about 

2–3 days. 

Patient 1 

The first case was in a 50-year-old man without a notable past history, 

who was diagnosed with multiple colorectal polyps. Four polyps were 

found: three flat polyps with a diameter of 2–5 mm in the sigmoid colon 


*Correspondence: yangzhiwen2009@sina.com † Wang Jing and Li Qinghua have contributed equally to this work 

1 

Department of Gastroenterology, Songjiang District Central Hospital, Shanghai, China 2 Department of Pharmacy, Songjiang District Central Hospital, Shanghai 201600, China 

©The Author(s) 2022 

15

FEATURE 

(Fig. 1A, B) and a flat polyp with a diameter of 4 mm in the rectum 

(Fig. 1C). He underwent colonoscopy with cold biopsy of a 4 mm rectal 

polyp (Fig. 1D), and the colorectal polyps were confirmed pathologically. 

Two hours after the operation, the patient developed a high fever 

up to 39.4 °C. Laboratory examinations revealed elevated infection 

indices, such as PCT 44.52 ng/mL, CRP 40.48 mg/L, white blood 

cell count (WBC) 17.3 × 10 9 /L and neutrophils 95.4%. The result of 

CT scan showed pleural effusion in lung (Fig. 2 A and B). No evidence 

of other explainable fever foci was found, and no microorganisms 

were found in blood cultures. Because of the serious colonoscopyassociated 

infection, the patient was transferred to the GICU and 

treated with antibiotic combined therapy consisting of meropenem 

(1.0 g administered intravenously every 12 h) and metronidazole (0.5 g 

administered intravenously every 12 h). His fever subsided within 1 day, 

thus indicating that the antibiotic therapy was effective. Eventually, the 

patient was discharged without any complications. 

Fig. 1 Colonoscopic examination of a 50-year-old man. A A flat 

polyp with a diameter of 3 mm in the sigmoid colon. B Two flat 

polyps with diameters of 3–5 mm in the sigmoid colon. C A flat polyp 

with a diameter of 4 mm in the rectum; D Rectal biopsy 

Patient 2 

The second case was in a 72-year-old woman with a history of 

hypertension and fatty liver, who underwent a colonoscopy that revealed 

13 polyps: four flat polyps with a diameter of 2–3 mm in the ileocecal part 

(Fig. 3A), a 4 mm papillary polyp in the liver flexure of the colon (Fig. 3B), 

a 3 mm flat polyp in the transverse colon (Fig. 3C) and seven flat polyps 


Fig. 2 chest and abdominal CT before and after colonoscopy. A Chest CT of a 50-year-old man. Normal CT before colonoscopy, but abnormal CT 

with pleural effusion after colonoscopy. B Abdominal CT of a 50-year-old man. Normal CT before and after colonoscopy. C Chest CT of a 72-year-old 

woman. Normal CT before colonoscopy, but abnormal CT with pleural effusion after colonoscopy. D Abdominal CT of a 72-year-old woman. 

Normal CT before colonoscopy, but abnormal CT with exudation in pancreas tail after colonoscopy 

16

FEATURE 

with diameters of 2–5 mm in the sigmoid colon (Fig. 3D). The colorectal 

polyps confirmed pathologically were resected by argon plasma 

coagulation (APC) under the condition of strong electrocoagulation 

2, 40 W APC power, and 0.8–1.2 L/min argon gas flow (APC ® 2 and 

electric generator vio ® 200D; ERBE Company, Tuebingen, German). One 

hour after the operation, the patient suddenly developed a high fever 

of 39.0°C, without cough, expectoration or abdominal pain. On the 

morning of the second day, the patient’s body temperature continued 

to rise to 40.0°C, Physical examination findings for the abdomen were 

negative, without evidence of intestinal perforation and hemorrhage. 

There was no abnormalities in routine urine examination, and no 

bacterial growth in blood culture examination. Laboratory examinations 

revealed 18.48 × 10 9 /L WBC, 96.1% neutrophils, more than 100.0 ng/ 

mL procalcitonin, 68.24 mg/L CRP. The result of CT scan showed 

pleural effusion in lung and exudation in pancreas tail (Fig. 2 C and D). 

Of note, the patient’s illness rapidly worsened, and she was transferred 

to the GICU, with poor gas analysis (PH7.384, PCO2 34.8 mmHg, PO2 

42.1 mmHg) and abnormal hepatic function results (ALT 145.9U/L, AST 

256.5U/L, r-GT 215U/L). After consultation with doctors, the patient’s 

symptoms, including type 1 respiratory failure and abnormal hepatic 

functions, were attributed to a colonoscopy-associated infection with 

subsequent gut bacterial translocation. The patient received intravenous 

therapy consisting of 1.0 g of vancomycin every 12 h for 3 days, and 

1.0 g of imipenem/cilastatin every 8 h for 5 days. After 2 days of therapy, 

her body temperature normalized. The patient’s gas analysis (PH7.439, 

PCO 2 

33.9 mmHg, PO 2 

93.3 mmHg) and liver function (ALT 27.74U/L, 

AST 20.99U/L, r-GT 67.79U/L) also recovered normally. Eventually, she 

was discharged without any complications. 

Discussion and conclusions 

In previously published reports, PPF has been considered a rare 

complication of colonoscopic polypectomy with slight clinical 

symptoms and good prognosis [5, 8]. To our knowledge, this study 

is the first report of patients with PPF presenting serious infectious 

symptoms leading to life-threatening complication, and rapid 

deterioration to type 1 respiratory failure and abnormal hepatic 

function. After antibiotic therapy, the patient condition rapidly 

recovered. 

Fig. 3 Colonoscopic examination of a 72-year-old woman. A Four 

flat polyps with diameters of 2–3 mm in the ileocecal part. B A 4 mm 

papillary polyp in the liver flexure of the colon. C A 3 mm flat polyp in 

the transverse colon. D Seven flat polyps with diameters of 2–5 mm 

in the sigmoid colon 

Seven patients were previously reported to develop PPF after 

colonoscopic polypectomy, of which four cases had a polyp 

diameter ≥ 2 cm, one case had a polyp 10–30 mm in diameter, and 

two cases had no polyps [5]. The median initial time of fever after 

polypectomy was approximately 7 h, and the median fever duration 

was approximately 9 h [5]. The seven patients with PPF had slight 

clinical symptoms with a good prognosis after antibiotic therapy [5]. 

CRP, a critical infection index, did not increase within 24 h [5]. In 

contrast to these cases, three exceptional findings in our study were 

observed. First, severe infection in patients with PPF was found, 

thus resulting in type 1 respiratory failure and abnormal hepatic 

function. Second, the patients with PPF had relatively smaller polyps 

of 2–5 mm in diameter. Third, CRP and PCT were significantly 

elevated within several hours. 

Lee et al. further discussed three possible mechanisms of PPF 

[5, 8]. The first is that PPF may be a mild form of PPCS that 

develops by transmural burn. With the exception of abdominal 

tenderness, PPF is similar in terms other clinical symptoms and 

risk factors to PPCS. Notably, transmural burn in the colon wall 

is significant in both PPF and PPCS, thus suggesting that both 

might be generated by the same mechanism. PPF and PPCS are 

initiated by different degrees of transmural burn, with or without 

actual intestinal perforation. The second is that gut bacteria may 

translocate to the bloodstream via mucosal wounds during the 

colonoscopic procedure. The incidence of transient bacteremia was 

approximately 4% within 10 min after polypectomy. Contamination 

by enteric bacteria is inevitable, even when a disinfected colonoscope, 

sterile needles and sterile injection fluid are used during colonoscopy [9- 

11]. For instance, the propofol formulation for intravenous administration 

may be a possible contamination factor [12]. The third is that PPF may 

be attributable to an inflammatory mechanism other than infection. 


17

FEATURE 


In general, polyps induce an inflammatory microenvironment 

with inflammatory cell infiltration and elevated proinflammatory 

cytokines, such as IL-6 and TNF-α. Thus, determining whether the 

patients with PPF developed fever because of the colonoscopy or the 

polypectomy itself is difficult. 

As previously reported, seven patients developed PPF, of which two 

cases had no polyps, and one case had polyps 10–30 mm in diameter 

[5]. This finding suggests that colonoscopic examination without 

colonoscopic polypectomy also affects the intestinal bacteria or causes 

minimal intestinal-barrier damage. The patients with PPF in our study 

had multiple relatively small polyps (2–5 mm in diameter), in contrast 

to the previously reported findings. Although the causes of PPF are 

complicated, we believe that gut bacteria are translocated to the 

bloodstream via mucosal wounds. 

PPCS, a rare and serious complication of colonoscopic polypectomy, 

results from an electrocoagulation injury to the bowel wall during 

polypectomy, which induces a transmural burn and localized peritoneal 

inflammation without clinical evidence of perforation on radiographic 

examination [13]. Within hours to 5 days after colonoscopic 

polypectomy, patients develop fever and other symptoms, including 

leukocytosis, localized abdominal pain and localized peritoneal signs. 

In summary, this study may increase clinical awareness regarding PPF 

after colonoscopy. Early recognition and antibiotic therapy are critical, 

which can improve patient prognosis and avoid severe outcomes. 

Abbreviations 

PPF: Postpolypectomy fever; PPCS: Postpolypectomy 

electrocoagulation syndrome; GICU: General intensive care unit; CRP: 

C-reactive protein; PCT: Procalcitonin; WBC: White blood cell count; 

APC: Argon plasma coagulation. 

Acknowledgements 

This study was supported by all physicians in the Department of 

Gastroenterology, Songjiang District Central Hospital, Shanghai, China. 

We thank International Science Editing for editing this manuscript. 

Authors’ contributions 

JW and QL designed the study. ZY analyzed data and wrote the 

manuscript. All authors have read and approved the final manuscript. 

Funding 

This case report was supported by Shanghai Municipal Health 

Bureau (201940471) and Shanghai Songjiang Science & Technology 

Commission (2017sjkjgg50), which supported data collection, analysis 

and manuscript writing. 


All information about the patient come from department of 

Gastroenterology, Songjiang District Central Hospital. The data used and 

analyzed during the current study are included in this article. 

Declarations 

Ethics approval and consent to participate 


Consent for publication 

The two patients gave written consent for their personal or clinical 

details along with any identifying images to be published in this study. 

Competing interests 

The authors declare no conflicts of interest. 

Author details 

1 

Department of Gastroenterology, Songjiang District Central Hospital, 

Shanghai, China. 2 Department of Pharmacy, Songjiang District Central 

Hospital, Shanghai 201600, China. 

Received: 8 October 2021 Accepted: 16 March 2022 

Published online: 29 March 2022 

References 

1. Barua I, Vinsard DG, Jodal HC, Løberg M, Kalager M, Holme Ø, et 

al. Performance of artificial intelligence in colonoscopy for adenoma 

and polyp detection: a systematic review and meta-analysis. 

Gastrointest Endosc. 2021;93(1):277–85. 

2. Benazzato L, Zorzi M, Antonelli G, Guzzinati S, Hassan C, Fantin 

A, et al. Colonoscopy-related adverse events and mortality in an 

Italian organized colorectal cancer screening program. Endoscopy. 

2021;53(5):501–8. 

3. Watabe H, Yamaji Y, Okamoto M, Kondo S, Ohta M, Ikenoue T, et 

al. Risk assessment for delayed hemorrhagic complication of colonic 

polypectomy: polyp-related factors and patient-related factors. 

Gastrointest Endosc. 2006;64(1):73–8. 

4. Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos 

G, et al. Risk of perforation from a colonoscopy in adults: a large 

population-based study. Gastrointest Endosc. 2009;69(3 Pt 

2):654–64. 

5. Lee SH, Kim KJ, Yang DH, Jeong KW, Ye BD, Byeon JS, et al. 

Postpolypectomy fever, a rare adverse event of polypectomy: 

nested case-control study. Clin Endosc. 2014;47(3):236–41. 

6. Waye JD, Lewis BS, Yessayan S. Colonoscopy: a prospective report 

of complications. J Clin Gastroenterol. 1992;15(4):347–51. 

7. Waye JD, Kahn O, Auerbach ME. Complications of colonoscopy 

and flexible sigmoidoscopy. Gastrointest Endosc Clin N Am. 

1996;6(2):343–77. 

8. Kim HW. What is different between postpolypectomy fever 

and postpolypectomy coagulation syndrome? Clin Endosc. 

2014;47(3):205–6. 

9. Levy MJ, Norton ID, Clain JE, Enders FB, Gleeson F, Limburg PJ, 

et al. Prospective study of bacteremia and complications with EUS 

FNA of rectal and perirectal lesions. Clin Gastroenterol Hepatol. 

2007;5(6):684–9. 

10. Low DE, Shoenut JP, Kennedy JK, Sharma GP, Harding GK, Den 

Boer B, et al. Prospective assessment of risk of bacteremia with 

colonoscopy and polypectomy. Dig Dis Sci. 1987;32(11):1239–43. 

11. Nelson DB. Infectious disease complications of GI endoscopy: part 

II, exogenous infections. Gastrointest Endosc. 2003;57(6):695–711. 

12. Rex DK, Deenadayalu V, Eid E. Gastroenterologist-directed propofol: 

an update. Gastrointest Endosc Clin N Am. 2008;18(4):717–25. 

13. Kus J, Haque S, Kazan-Tannus J, Jawahar A. Postpolypectomy 

coagulation syndrome—an uncommon complication of 

colonoscopy. Clin Imaging. 2021;79:133–5. 

Publisher’s Note 

Springer Nature remains neutral with regard to jurisdictional claims in 

published maps and institutional affiliations. 

18

FEATURE 

WITH YOUR HELP 

We’ve made 

Gastroenterology a true 

7 day NHS service 

Join forces with the UK’s largest campaign to see and 

treat those NHS patients who need you most. All working 

as part of an expert clinical team in outpatient clinics or 

undertaking Endoscopy procedures, getting the right care 

to those patiently waiting. 

Register your support or enquire below. 

Together, we can end the wait. 

www.ukmedinet.com 


19

NEWS 

ASSESSING STOMACH HEALTH TO IMPROVE 

GASTRIC CANCER DIAGNOSIS 

Chronic gastrointestinal problems can signal something 

serious, such as atrophic gastritis (AG) or gastric intestinal 

metaplasia – both neoplastic conditions – which are often 

initiated by Helicobacter pylori infection. There are currently 

several methods to diagnose H. pylori, including a stool 

antigen test or urea breath test, which do not show the level 

of mucosal damage from AG, or gastroscopy, an invasive 

procedure that often has long waiting lists. From a clinical 

point of view, it is vital to identify AG as early as possible, as it 

is a significant risk factor for gastric cancer, a condition that is 

often diagnosed at a late stage – carrying an abysmal five year 

survival rate of 20.7 % in the UK – and requires surveillance. 

The recent guidelines from the British Society of 

Gastroenterology (BSG) recommend that the key to early 

cancer detection is to non-invasively detect pre-cancerous 

conditions before endoscopy. However, the current diagnostic 

pathway for patients presenting with stomach complaints 

is ambiguous, and they often remain in primary care too 

long – delaying diagnosis – or are referred too soon, where 

gastroscopy identifies no pathology. BIOHIT HealthCare Ltd 

has developed a test to help screen these high risk patients 

in primary care, enabling GPs to confidently identify patients 

who can be managed symptomatically, or otherwise should be 

referred to a specialist for gastroscopy. 

provides results in just 15 minutes, enabling quick and reliable 

diagnosis of both symptomatic and asymptomatic patients 

with stomach problems. This can help identify patients with 

AG sooner, and with comparable accuracy to the current gold 

standard methods – gastroscopy and histology – to select 

patients that require further examination. 

The GastroPanel Quick Test is a cost-effective method that helps 

to improve the management of patients with gastrointestinal 

problems. Importantly, it bridges the gap in the diagnostic 

pathway, potentially identifying pre-neoplastic conditions in 

primary care, and increasing the diagnostic yield in secondary 

care by only referring patients in the higher risk category. This 

could lead to more gastric cancers being detected at an earlier, 

more curable stage, while at the same time reducing both the 

cost and volume burden on healthcare resources. 

The GastroPanel Quick Test is now available in the UK. For more 

information visit our website biohithealthcare.co.uk or see us in 

person at stand A56 at BSG Live 22 for a live demonstration of 

the GastroPanel Quick Test. 

For more information about GastroPanel 

contact: info@biohithealthcare.co.uk 

The GastroPanel ® Quick Test is a non-invasive blood test 

that investigates H. pylori infection and measures three 

stomach-specific biomarkers – pepsinogen I, pepsinogen II 

and gastrin-17 – to rapidly detect AG, offering more decisive 

clinical information compared to an H. pylori test alone. It 

can easily be performed during a clinical appointment, and 


For the early diagnosis 

of gastric cancer risk 

Reduce endoscopy waiting lists and 

improve the diagnostic pathway for 

patients, through an earlier, faster 

and more cost-effective approach. 

20 

www.biohithealthcare.co.uk

NEWS 

The debilitating gut 

condition affecting 

thousands of women 

New resources published today by Guts UK 

to raise awareness of microscopic colitis 

show that women are 700% more likely 

than men to suffer with the condition. 

The charity is calling for more research to 

determine the reasons behind this gender 

disparity in the hope it will lead to prevention, 

faster diagnoses and developments in 

treatments. 

Microscopic colitis is an inflammation of the 

large intestine (bowel) that causes persistent, 

frequent and watery diarrhoea (throughout the 

day and night), stomach pain, fatigue, faecal 

incontinence and weight loss. The charity has 

chosen to create specific resources for women 

as part of Microscopic Colitis Awareness Week 

after research has shown that 87.5% of people 

suffering with the condition are female - most 

of whom are diagnosed between the ages of 

50 and 70. [1] [2] 

Microscopic colitis is a leading cause of 

diarrhoea in older adults and it can have a 

devastating impact on a person’s quality of life. 

Scientists estimate that around 67,200 people 

are living with microscopic colitis in the UK. 

[3] [4] 

Patients often find it difficult to manage 

jobs, socialise, travel and take part in family 

life because of the urgent nature of their 

symptoms and their need to be near to toilet 

facilities at all times. Coping with this often 

leaves sufferers feeling very isolated and can 

have a significant and detrimental effect on 

their mental wellbeing. 

Many people suffer for years with microscopic 

colitis but the correct diagnosis and treatment 

can make a huge and dramatic difference to a 

person’s quality of life. 

Julie, aged 42 from Sidcup in Kent, was 

diagnosed with microscopic colitis in 2020. 

Julie said: 

“The symptoms of microscopic colitis are 

awful. I experienced crippling stomach pain, 

nausea as well as watery diarrhoea which 

lasted for several weeks and only stopped 

when I was diagnosed and began a treatment 

of steroids. It all had a massive impact on 

mental health since this was during lockdown 

and I worried about what could be wrong. 

“It’s a very isolating condition and I can 

understand why it’s called a hidden disability. 

It’s been over a year since I was diagnosed 

and I’m still having flare-ups. I am constantly 

thinking about what I am eating and when I 

am out where the nearest facilities are - it’s 

exhausting.” 

At least 1 in 1,000 people are thought to have 

microscopic colitis in the UK with 17,000 new 

cases being diagnosed each year, but the real 

number could be a lot higher because it’s often 

underreported and misdiagnosed.[5] [6] One 

study showed that one in three patients 

with microscopic colitis were initially 

incorrectly diagnosed with Irritable Bowel 

Syndrome. [7] It is also a growing disease and 

the number of patients diagnosed has been 

increasing over the past 20 years. [8] 

Microscopic colitis is named because, unlike 

other inflammatory bowel diseases (IBD), like 

Crohn’s disease or ulcerative colitis, it can’t 

be diagnosed with a colonoscopy alone and a 

sample of tissue taken from the bowel must be 

examined under a microscope to identify the 

condition. However, once confirmed, treatment 

with prescribed medicine (a steroid called 

budesonide) is available and has shown to be 

very effective and often life-changing. [9] 

The causes of microscopic colitis and the 

reason it affects women disproportionately 

are still unclear. As it is a relatively new 

disease (first described in 1976) it has led 

WHY NOT WRITE FOR US? 

Gastroenterology Today welcomes the submission of 

clinical papers and case reports or news that 

you feel will be of interest to your colleagues. 

Material submitted will be seen by those working within all 

UK gastroenterology departments and endoscopy units. 

All submissions should be forwarded to info@mediapublishingcompany.com 

If you have any queries please contact the publisher Terry Gardner via: 

info@mediapublishingcompany.com 


21

NEWS 

Thousands of 

healthcare professionals 

recommend Symprove 

Symprove is a live liquid-based probiotic 

containing four strains of bacteria* 


Evidence-based: Independent research conducted at 

University College London and King’s College London. 

Safety: Well tolerated, long history of safe use. 

All strains are fully characterised. 

Here are the reasons why: 

Survival: In vitro/in vivo research demonstrating 

viability of bacteria through the gut. 

Formulation: Manufactured to ensure 

bacterial tolerance through the gut. 

For more information please visit: symproveforprofessionals.com 

22 

*Lacticaseibacillus rhamnosus NCIMB 30174, Enterococcus faecium NCIMB 30176, Lactobacillus acidophilus NCIMB 30175, Lactiplantibacillus plantarum NCIMB 30173.

NEWS 

to a presumption that it is environmental 

as opposed to genetic factors that are 

responsible for its occurrence. [10] 

have to, so my main message this Microscopic 

Colitis Awareness Week is don’t suffer in 

silence and seek help from your GP if you’re 

experiencing symptoms.” 

[10] https://www.ncbi.nlm.nih.gov/pmc/ 

articles/PMC8776530/#B4 

[11] Lansoprazole and omeprazole are the 

most commonly known. 

Prior studies have suggested that a range of 

medications including proton pump inhibitors 

(PPIs) - which are used to reduce stomach 

acid [11], nonsteroidal anti-inflammatory drugs 

such as ibuprofen, statins, antidepressants, 

aspirin, and beta blockers may be associated 

with the disease as well as cigarette smoking 

and a co-diagnosis of an auto-immune 

disease. [12] [13] 

What is clear is that women are at substantially 

higher risk of having microscopic colitis 

than men. [14] Despite this marked gender 

discrepancy, the literature on reproductive 

and hormonal factors is very limited. Some 

scientists have hypothesised that there is a 

link with microscopic colitis and the use of 

oral contraceptive pills and HRT [15] but more 

research is needed for this to be conclusive. 

Julie Harrington, CEO of Guts UK, said: 

“Thousands of people across the country are 

quite literally housebound with symptoms of 

microscopic colitis and we now know that 

the rates are increasing and are likely to grow 

further as the population ages. 

“Further research is desperately needed to 

identify risk factors and find out why women 

are far more likely to suffer from microscopic 

colitis so we can move to a place where 

prevention and faster diagnosis is possible. 

“In the meantime, I hope that this year’s 

Microscopic Colitis Awareness Week will raise 

awareness of this extremely difficult condition 

and that sufferers discover the simple 

treatments that can make a huge and dramatic 

difference to their quality of life.” 

Professor Shaji Sebastian, Consultant 

Gastroenterologist at Hull University Teaching 

Hospitals NHS Trust and Guts UK trustee added: 

“Scientists still don’t fully understand what 

causes microscopic colitis and further research 

is clearly needed to determine what could be a 

combination of factors. 

“What we do know is that the condition can 

be very debilitating but with the right tests it’s 

also very treatable. Early diagnosis is crucial to 

prevent patients from suffering when they don’t 

Julie from Sidcup added: 

“There is very little awareness of microscopic 

colitis, but I am sure there are many people 

suffering with it without knowing. My 

message for anyone with symptoms is that 

if you feel that things aren’t quite right and 

you’re struggling to get a diagnosis then 

persevere and push for an appointment with 

a gastroenterologist. The treatments available 

can certainly improve symptoms.” 

Anyone experiencing symptoms is advised 

to see their GP, contact Guts UK for more 

information or visit gutscharity.org.uk 

#MicroscopicColitisAwareness 

[1] 7:1 female to male meaning 87.5% 

of people with the condition are 

women and women are 700x more 

likely to have the condition than men: 

https://drive.google.com/drive/u/2/ 

folders/1LxFK0CEv_1JqSLrfg-Vp7p179T_ 

hxYBP - Other studies have said it may 

be as high as 9:1. 

[2] https://gutscharity.org.uk/advice-andinformation/conditions/microscopiccolitis-2/ 


articles/PMC8776530/ 

[4] Aprox. 67,222 people are living with 

Microscopic Colitis in the UK - around 

59,000 women and 8,000 men. 

[5] https://www.crohnsandcolitis.org.uk/ 

about-crohns-and-colitis/publications/ 

microscopic-colitis 

[6] Tong J et al. Am J Gastroenterol 2015; 

110(2): 265-76. Office for National 

Statistics. Statistical Bulletin: 26 June 

2019.https://pubmed.ncbi.nlm.nih. 

gov/25623658/ 

[7] Limsui D et al. Inflamm Bowel Dis 2007: 

13(2): 175-81 https://www.ncbi.nlm.nih. 

gov/pmc/articles/PMC4754103/ 

[8] Münch A, Aust D, Bohr J, Bonderup O, 

Fernández Bañares F, Hjortswang H, et 

al. Microscopic colitis: current status, 

present and future challenges: statements 

of the European Microscopic Colitis 

Group. J Crohns Colitis (2012) 6(9):932– 

45. doi:10.1016/j.crohns.2012.05.014 

PubMed Abstract | CrossRef Full Text | 

Google Scholar 

[9] https://gutscharity.org.uk/advice-andinformation/conditions/microscopiccolitis-2/ 



[13] https://www.crohnsandcolitis.org.uk/ 

about-crohns-and-colitis/publications/ 

microscopic-colitis 

[14] Weimers P, Ankersen DV, Lophaven S, 

Bonderup OK, Münch A, Løkkegaard 

ECL, Burisch J, Munkholm P. Incidence 

and prevalence of microscopic colitis 

between 2001 and 2016: A Danish 

nationwide cohort study. J Crohns Colitis. 

2020 [PubMed] [Google Scholar] 



Health care professionals 

urged to ‘think EOE’ for 

patients suffering from 

dysphagia or food bolus 

obstruction 

An easily treatable, upper GI condition 

which causes dysphagia and food bolus 

obstruction, is going undiagnosed, 

sometimes for years, 1 leaving thousands of 

sufferers needlessly living with significant 

discomfort, anxiety and embarrassment. 

Additionally, Eosinophilic Oesophagitis 

(EoE) is known to be the most common 

single reason for attendance at A&E for 

food bolus obstruction removal. 2 Yet 

despite this, EoE - which is believed to 

affect around 23,500 people in the UK 2 – 

takes on average up to eight years to be 

diagnosed. 3 

Now the UK charity EOS Network is running 

a clinical and public awareness campaign 

urging both the general public and healthcare 

professionals, in particular A & E doctors and 

nurses, GPs and practice nurses, to ‘Think 

EoE’. During the Awareness Week, volunteers 

will be visiting GP surgeries with patient leaflets 

and posters whilst the EOS Network clinical 

community are being encouraged to put up 

‘Think EoE’ posters in their staffrooms. 

Eosinophilic Oesophagitis (EoE) is an immunemediated 

disease, most probably caused by 

food allergies or other environmental ‘triggers’ 

which occurs in the upper gut or oesophagus. 

(SEE NOTES BELOW AND MEDIA PACK). 

This results in inflammation of the mucosa in 


23

NEWS 

the oesophagus which, if left untreated, can 

lead to oesophageal remodelling including the 

formation of furrows leading to strictures. In turn 

this creates the difficulties with swallowing food. 

Sufferers of Eosinophilic Oesophagitis (EoE) will 

typically have a history of ‘slow eating,’ drinking 

lots of water whilst eating and avoiding tough, 

chewy or starchy foodstuff such as meat, rice 

and bread. They are often labelled ‘fussy eaters’ 

and may avoid social eating occasions for fear 

of choking, coughing or retching in public. 

EoE was identified as a disease in the 1990s, 

yet many primary care physicians are still 

unaware of the condition, often mistaking it 

for GORD (gastro-oesophageal reflux disease) 

or dyspepsia, 4 whilst patients admitted to 

A&E with food bolus obstruction will typically 

be referred back to their GP rather than to a 

gastroenterologist. 

An EoE diagnosis requires 6 biopsies taken 

from at least 2 sites in the oesophagus to 

specifically count the number of eosinophils 

present. Yet whilst diagnosis is relatively 

straightforward, lack of clinical awareness 

means that opportunities are often missed, 

and the patient can spend years going 

between GP and hospital in a search for the 

cause of their discomfort. Some patients have 

even been told that the condition is caused by 

psychological issues. 

‘Whether it is at primary care level, at A&E 

or even during referral to a gastroenterology 

department, far too many of our members 

are reporting years of missed opportunities 

for diagnosis at every step of their disease 

journey,’ explains Amanda Cordell, CEO of the 

EOS Network. 

‘Therefore, it is extremely important that we 

improve the awareness of this condition 

amongst not just the public, but healthcare 

professionals too.’ 

‘EoE has a considerable impact on the quality 

of life and the self-esteem of patients,’ explains 

Professor Stephen Attwood, Consultant 

Surgeon and Honorary Professor at Durham 

University, and one of the first doctors to 

identify and highlight the condition. ‘Not only 

do many develop adaptive eating strategies 

such as prolonged chewing, drinking copious 

amounts of liquids and avoiding certain foods, 

they also dread social situations and even 

eating with the families. Adults can be labelled 

as having psychological eating disorders whilst 

young children often fail to thrive and can suffer 

from malnutrition. 

‘Therefore, it is vital that there is greater 

general and clinical awareness of the 

condition. A key message for clinicians 

has to be that any patient who presents 

with pain on eating or feeling that food is 

sticking in the throat – especially if they 

have a history of allergic illnesses such as 

rhinitis asthma and eczema – should be 

referred for biopsies with a specific request 

to look for eosinophils. On diagnosis the 

gastroenterologist and patient should 

discuss the treatment options. These may 

include dietary exclusions - although these 

can often be difficult to maintain - PPIs 

that are effective for some patients or a 

topical steroid delivered directly to the site 

of inflammation that has been shown to 

maintain clinical and pathologic remission 

for 48 weeks in many patients. All patients 

need follow up and a long term care plan to 

manage this chronic disease.’ 

Amanda Cordell comments ‘Our aim is to 

ensure that patients are empowered with 

information to take to their clinicians and that 

clinicians in all specialities are aware of EoE 

so that they recognise the symptoms reported 

by their patients, Think EoE and provide the 

appropriate care. This will be further supported 

by the first British medical diagnosis and 

treatment guidelines which we expect to see 

published later this year. 

‘EoE is a very unpleasant and life-changing 

condition, but conversely it is relatively easy to 

recognise, diagnose and treat,’ ‘We hope our 

campaign will remind everyone to ‘Think EoE’ 

and help to make this happen.’ 

WHY NOT WRITE FOR US? 


Gastroenterology Today welcomes the submission of 

clinical papers and case reports or news that 

you feel will be of interest to your colleagues. 

Material submitted will be seen by those working within all 

UK gastroenterology departments and endoscopy units. 

All submissions should be forwarded to info@mediapublishingcompany.com 

If you have any queries please contact the publisher Terry Gardner via: 

info@mediapublishingcompany.com 

24

NEWS 

Eosinophilic Awareness Week 16 – 22nd May 

launched the ‘Think EoE’ campaign. EOS 

Network activities include the development 

of a patient information pack including a food 

obstruction patient action plan and symptom 

tracker, and emergency care education 

through an A&E awareness poster. Additionally, 

members of the EoE community will be visiting 

local GPs to provide information leaflets and 

posters to help with wider understanding of the 

disease and recognition of the symptoms. 

Find out more at www.eosnetwork.org 

For EoE case studies, or to interview Amanda 

Cordell, please contact Isla Whitcroft at Healthy 

PR on 07768661189 or email Islawhitcroft@ 

healthypr.co.uk 

About the EOS Network Charity 

The EOS Network’s mission is to ensure 

that every person with an Eosinophilic 

Gastrointestinal Disease receives a prompt 

accurate diagnosis, the right treatment for 

them and support to live with their condition. 

Its vision is for a world where everyone with an 

Eosinophilic Gastrointestinal Disease can eat 

without pain. 

The EOS Network provides information and 

support for patients and their families, a 

global platform for clinicians and researchers, 

educational resources and events and works 

with medical bodies, manufacturers and 

funders to ensure that the patient’s voice is 

heard. 

Brief notes on EOE (for more detail see 

media pack) 

EoE is clinically characterized by oesophageal 

dysfunction and histologically characterized by 

an eosinophil-rich inflammation, most probably 

caused by common food allergies or other 

environmental triggers. Often misdiagnosed as 

GORD, 4 adult symptoms include dysphagia, 

bolus obstruction and chest pain related 

to swallowing, heartburn and regurgitation. 

In children they can include reflux-related 

symptoms, nausea, vomiting, abdominal pain, 

refusal to eat or failure to grow. 2 Untreated 

EoE can lead to oesophageal remodelling 

including the formation of strictures. EoE 

is the cause of more than 50% of all 

emergency presentations for oesophageal 

food bolus impactions. 1 

Annual incidence rates of EoE in western 

countries are 7 cases per 100,000 with 

prevalence rates of 34 per 100,000. 2 However 

for patients with dysphagia and bolus 

50%. 5 Many patients have a history of atopy, 

particularly asthma, allergic rhinitis and eczema. 6 

EoE only received classification in the 1990s 

and disease awareness, amongst both 

clinicians and the general public, is thought to 

be low. Currently, average time to diagnosis 

is up to 8.1 years. 2 Due to the patchy nature 

of the disease, diagnosis requires six biopsies 

to be taken from around the oesophagus via 

endoscopy. Diagnosis is defined by histological 

presence of eosinophils ≥15hpf. 

Treatment for EoE is focused around three 

areas: dietary exclusion, drugs and dilatation. 

Dietary exclusion is generally considered 

hard to maintain and costly. Dilatation, 

carried out when the disease has progressed 

to oesophageal strictures, is an invasive 

procedure which manages the symptoms 

but not the cause of EoE and often has to be 

repeated. 

Until recently, all drug treatments were off-label 

and topical steroid therapy was not optimised 

for delivery to the oesophagus. However 

after approval from the EMA, NICE and the 

SMC have now recommended budesonide 

orodispersible tablet (Jorveza ® ) for active EoE 

in adults, a treatment option designed to reach 

the area of inflammation in the oesophagus 

Current clinical guidelines can be found @ 

obstruction, prevalence can be between 23- 

https://www.eosnetwork.org/medicalguidelines 

References 

1. Gastrointest Pharmacol Ther 2016; 7(2): 

207-13. Ahmed M. World J 

2. Orodispersible budesonide tablets for the 

treatment of eosinophilic esophagitis: a 

review of the latest evidence. Ther Adv 

Gastroenterol 2020, Vol. 13: 1–15. Miehlke 

S, Lucendo AJ, Straumann A, Bredenoord 

AJ and Attwood S 

3. Gastrointest Pharmacol Ther 2016; 7(2): 

207-13. Ahmed M. World J 

4. Eosinophilic esophagitis N Engl J Med. 

2015;373(17):1640–8. Furuta GT, Katzka 

DA. 

5. Prevalence of eosinophilic oesophagitis in 

adults presenting with oesophageal food 

bolus obstruction. World J Gastrointest 

Pharmacol Ther 2015;6:244–247. Heerasing 

N, Lee SY, Alexander S, et al 

6. Aliment Pharmacol Ther 2016; 43(1): 3-15. 

Arias Á et al 

Amanda Cordell Interview 

As awareness of the upper GI condition 

Eosinophilic Oesophagitis grows, including 

its significant impact on the quality of life 

for those affected, we talk to Amanda 

Cordell, Chair and Founder of the charity 

The EOS Network, to discover the inspiring 

story behind the founding of the charity 

which supports both patients and clinicians 

working in this field. 

When Amanda Cordell’s seven month old baby 

Samuel was diagnosed with multiple protein 

allergies and eosinophilic gastrointestinal 

disease back in 2003, she naturally searched 

around for any information which would help 

her to support her son. 

‘It quickly became clear that there was absolutely 

nothing out there,’ says Amanda. ‘My husband 

and I felt completely helpless and very isolated.’ 

Today, Amanda is chair of the The EOS 

Network, which grew out of a Yahoo support 

group that she formed in 2005. The Network 

has a strong community of parents, carers 

and adult patients and over 2,000 followers on 

social media. The Network provides them with 

somewhere to turn for support, advice and gold 

standard information on eosinophilic diseases 

which run throughout the gut. Eosinophilic 

Oesophagitis (EoE) is the most common 

disorder, and a significant cause of oesophageal 

dysphagia and food bolus, whilst Eosinophilic 

Gastroenteritis (EGE), Gastritis (EG), and Colitis 

(EC), all appear in the middle and lower gut. 

In addition, over 100 clinical professionals from 

13 countries have already signed up to the 

charity’s Professional Network, all benefitting 

from rapid access to the latest clinical 

research, guidelines, medical education, 

patient resources as well as global networking 

and discussion opportunities. There are also 

collaborative partnerships with medical bodies 

‘Our professional network provides a platform 

to connect, collaborate and innovate in all 

things Eosinophilic,’ says Amanda. ‘In addition, 

the ripple effect means that our members can 

educate their colleagues about the condition 

which is, of course vital, if more patients are to 

be helped. 

‘As a patient advocate and as the parent of 

two children living with eosinophilic diseases, 


25

NEWS 

I understand that it can feel like a pretty 

hopeless situation. Having an HCP in your 

corner who is supportive and knowledgeable 

makes such a huge difference.” 

When Amanda Cordell’s son Samuel was born 

17 years ago, he slept peacefully through the 

first night of his life. It was the last time he was 

to enjoy that simple luxury. 

‘The signs that something was wrong with 

Samuel were there from the first few days of 

his life, says Amanda. ‘He always seemed 

uncomfortable and never settled at night. 

He was a fussy eater who vomited up my 

breast milk, he developed cradle cap and then 

eczema which become infected so badly that 

he had to be admitted to our local hospital.’ 

In hospital Samuel caught Rotavirus and was 

placed on a special feed but even when he 

was well enough to be discharged, he still 

suffered constant vomiting, whilst his explosive 

bowel movements overflowed his nappy. 

‘We hardly slept for months,’ remembers 

Amanda. ‘We would take it in turns to walk 

up and down with him all night whilst he cried 

or was sick. We were new parents, so it was 

sometimes hard to know what was normal 

and our GP and the local hospital seemed to 

have little idea on how to help us. David and 

I were convinced however, that there was a 

connection between his bowel issues, eczema 

and vomiting.’ 

where people understood what you were going 

through but also where there was hope for the 

future. I came back to the UK and started up 

an online UK support group and things just 

went from there.’ 

‘We quickly discovered that there was a 

whole raft of people, often with very poorly 

children who were simply desperate for help. 

On the clinical side there was clearly a huge 

knowledge gap and a lack of consensus on 

how to treat these patients. 

Their daughter Heather born in 2007 was also to 

develop gut problems, eczema and immediate 

allergies. “It was devasting to hear our daughter 

also be given an eosinophilic diagnosis.” 

We spent the next few years raising funds and 

with the support of other families affected by 

eosinophilic diseases in 2010, we registered 

our group as a charity. 

‘Sadly, in December 2013, Samuel became 

seriously ill and I was forced to a back seat for 

a few years, but in the meantime the need for 

research, diagnosis consensus and treatments 

became even greater.” 

‘I went back to Cincinnati for the 2017 CURED 

conference and was completely humbled 

by the great work that the researchers 

and patient advocates had done in driving 

forward awareness and change in the USA. 

The meeting had attendees and presenters 

from around the globe, including the UK’s 

Professor Stephen Attwood who first identified 

eosinophilic oesophagitis. I came back inspired 

with the aim of bringing together the global 

expertise to improve disease awareness, 

access to medical care and patient support for 

all those suffering with eosinophilic diseases.’ 

The charity was relaunched in 2019 as 

the EOS Network, now supported by a 

medical and scientific board. The change 

in constitution provided two arms, one a 

community hub for patients and their families 

and the other a global network for HCPs. 

‘There is a real need to expand our reach, 

to more patients their families and HCPs, ‘ 

says Amanda. ‘Both here and abroad it is still 

difficult for people to get in front of an HCP who 

understands EOS diseases which can mean a 

delay in diagnosis and access treatments. The 

last 8 months have been a huge success but 

there is still a lot of work to be done.” 

If you need more information or you would like 

to get involved go to www.eosnetwork.org or 

email contactus@eosnetwork.org 

At seven months, Samuel was referred to a 

paediatric gastroenterologist who diagnosed 

him with eosinophilic gastrointestinal disease 

as the cause of his relentless symptoms. 


‘We didn’t know it then, but we were at the start 

of a very long, tough journey,’ says Amanda. 

Samuel was placed on a highly restrictive 

diet with elemental feed and Amanda started 

to search for information that might help her 

and David to support their son. Whilst there 

was virtually no information on the condition 

in the UK and Europe, Amanda learned about 

the work being carried out into gut allergies 

and eosinophilic disorders at the Cincinnati 

Children’s Hospital. In 2005 she and her 

husband David attended a conference when, 

for the first time, they realised the value of 

having a support group. 

‘It was such as relief to be in an environment 

26

NEWS 

Building a world where 

cancer is diagnosed 

earlier and faster 

At Cyted we exist to tackle 

the 10 million global cancer 

deaths every year. Our digital 

platform and award-winning 

Cytosponge diagnostic tool is 

transforming cancer detection. 

By enabling clinicians to make 

decisions quicker and with 

more confidence, they are 

detecting disease earlier 

and saving lives faster. 

The Cytosponge is a patient-friendly 

early detection test for oesophageal 

cancer in people living with heartburn 

or reflux symptoms. This test is a 

‘sponge-on-a-string’ device, coupled 

with next generation biomarkers, to 

collect cells from the oesophagus, which 

are then sent to the Cyted laboratory 

for processing and analysis through 

our digital platform. Pathologists are then 

guided to the location that needs their 

attention in seconds to identify the 

patients who are most at risk of Barrett’s 

oesophagus, a precursor to oesophageal 

cancer. 

Close to 1% of the global population 

suffer from Barrett’s oesophagus. 

Traditionally, it is diagnosed by 

performing an upper gastrointestinal 

endoscopy. However, the Cytosponge 

can prioritise patients for endoscopy, 

reducing unnecessary procedures, 

cutting wait times and providing patients 

with an earlier and faster diagnosis. 

This could lead to saving 

thousands of lives every 

year. 

As a result of its success 

in clinical adoption and 

innovation, the Cytosponge 

is now being implemented 

across England and 

Scotland to diagnose 

and monitor Barrett’s 

oesophagus. To support 

the NHS reset and recovery 

of endoscopy services, 

Cyted has also received funding from 

Small Business Research Initiative (SBRI) 

Healthcare to pilot the Cytosponge in 

community care settings. Healthcare 

professionals will receive training to 

deliver the Cytosponge and establish 

their own clinics in GP centres and 

NHS community diagnostic centres. 

If successful, this service model for 

the Cytosponge could be considered 

and adopted by other regions across 

the UK. 

A new trial (BEST4) will begin later 

this year to explore if the Cytosponge 

can prevent deaths from oesophageal 

cancer when offered as a screening 

test to people on long-term medication 

for heartburn, which is one of the most 

common symptoms for Barrett’s 

oesophagus. This trial could lead to 

the Cytosponge being established as a 

routine screening programme, providing 

patients with a less invasive option and 

clinicians with targeted endoscopy 

referrals to improve early detection 

of cancers. 

The Cytosponge is fundamentally 

changing the clinical landscape in how 

doctors approach, and how patients 

with worrying upper GI symptoms 

receive care. This was recognised 

at the 2022 Prix Galien UK Awards, 

where Cytosponge was awarded 

Best Medical Technology. 

The Cytosponge is supported by 

high-quality research at a global level 

too, having been recognised by the 

American College of Gastroenterology 

(ACG). In its latest clinical guidelines, 

the ACG praises the evidence base, 

and clinical experience. Their 

recommendation to apply the 

Cytosponge for the screening of 

Barrett’s oesophagus will transform 

outcomes for thousands of patients 

and clinicians. 

For more information, 

please visit www.cyted.ai 


27

REPORT 

THE COST OF OPIOID-INDUCED CONSTIPATION (OIC) 

AN ESSENTIAL REPORT INTO THE FINANCIAL AND 

PERSONAL COST OF OIC 

May, 2022 – Opioids are widely used to treat serious pain, 

including in patients with cancer. The majority of these 

patients will experience the side-effect of opioid-induced 

constipation (OIC), caused by the opioids binding to the 

μ-receptors in the enteric system. 

aware of the importance of diagnosing OIC, monitoring the condition 

and providing appropriate treatment. For example, peripheral-acting mu 

opioid receptor antagonists (PAMORAs) are a unique class of drugs that 

act directly on the mechanism causing OIC, and are therefore far more 

effective than traditional treatments. 

There has been a sharp increase in the prescribing of opioids to patients 

with chronic pain. However, despite the debilitating side effect of 

constipation many healthcare professionals continue to prescribe opioids. 

Recommendations 

The Cost of Opioid-induced Constipation report recommends that 

clinicians: 


28 

OIC has a devastating effect on people’s lives but is often treated with 

laxatives, which have limited effect. OIC frequently has a negative impact 

on patients’ quality of life, including their ability to perform daily activities 

and work productively, yet there is little recognition of the condition and 

how to manage it. 

The Bowel Interest Group’s latest report, The Cost of Opioid-induced 

Constipation, will be published in June and sets out to educate primary 

and secondary healthcare professionals in the management of OIC. 

Key facts 

• Studies suggest that OIC affects between 41% and 57% of patients 

taking opioids for pain and 87% of patients with terminal cancer using 

opioids. 1 

• Doctors are prescribing laxatives for OIC, even though their 

effectiveness is limited. 

• Constipation is one of the most common reasons patients avoid 

taking opioid treatments or stop taking them. 

• There appears to be a clear relationship between higher levels of 

opioid analgesic prescribing and laxative prescribing rates. 2 

• There is a close correlation between opioid prescribing rates and 

admissions to hospital for constipation. 3 

• In 2018-19, the estimated annual spend by NHS England on 

constipation was £168 million. 4 

• In 2021, nearly 23 million opioid analgesic prescriptions were 

dispensed in the community, at a cost of approximately £202 million. 2 

OIC is underdiagnosed and therefore undertreated 1 or sometimes 

inappropriately treated. Not all doctors adhere to the Rome IV criteria 

for diagnosing OIC. Conventional treatments such as dietary changes 

and laxatives are rarely effective in treating OIC, but doctors continue to 

prescribe them. 

OIC can be very psychologically distressing for patients, who may 

choose to manage the condition themselves. This can include reducing 

their dose of opioids or even stopping taking opioids altogether. 

Better education of health professionals is needed so that they are 

Refences 

1. Cobo Dols M., Beato Zambrano C., Cabezón-Gutiérrez L., et al. (2021). One-year efficacy and safety of naloxegol 

on symptoms and quality of life related to opioid-induced constipation in patients with cancer: KYONAL study. 

BMJ Supportive & Palliative Care. 

2. Prescription data for section code 040702 (Opioid Analgesic Prescribing), 0106 Laxative Prescribing), and 

010606 (PAMORA Prescribing) from Jan 2017 – Dec 2021. Accessed March 2022 from NHS BSA England 

Prescribing Database and Openprescribing.net. 

• take a more proactive approach in the management of OIC, using a 

standard, symptom-based definition of the condition 

• educate themselves about treatment options 

• ask the patient regularly about symptoms 

• ensure that patients receive therapy that manages their pain 

appropriately while avoiding the debilitating consequences of OIC. 

Professor Anton Emmanuel, Professor in Neuro-Gastroenterology 

at University College London and Consultant Gastroenterologist at 

University College Hospital and the National Hospital for Neurology and 

Neurosurgery (Queen Square), says: 

“The Cost of Opioid-Induced Constipation Report emphasises the 

devastating impact that OIC has on patients, who face a stark choice of 

whether to endure the impact of chronic pain, or the pain of the constipation 

that results from taking the very painkillers that should be helping them. 

Patients' quality of life is severely impacted by the condition – what they are 

experiencing is often very distressing, not just a ‘nuisance’. Studies suggest 

that OIC affects between 41% and 57% of patients taking opioids for pain, 

and up to 87% of patients with terminal cancer using opioids. 

“OIC is often misdiagnosed and therefore sometimes inappropriately 

treated. Usual constipation treatments such as diet changes of 

prescribing of laxatives rarely work in treating OIC, because they do 

not target the underlying cause; the opioid binding to the μ-receptors. 

Inappropriate treatment leaves many patients to attempt to treat the 

condition themselves, while all the time enduring their chronic pain. 

More education for healthcare professionals in diagnosing, appropriately 

treating and managing OIC is needed. The Cost of Opioid-Induced 

Constipation Report highlights the urgency of the need and also the 

cost, both in terms of the financial cost to the NHS, and the cost of the 

impact on patients’ wellbeing and quality of life.” 

The full report will be available on the Bowel Interest Group’s website in 

June. 

For more information on the work of the Bowel Interest Group, visit 

www.bowelinterestgroup.co.uk. 

3. Admissions data for ICD 10 diagnosis code K59.0 (Constipation) from April 2016 to January 2020. Accessed May 

2020 from Vantage System provided by Health IQ. 

4. Bowel Interest Group (2020). Cost of constipation report. 2020. Available from: https://bowelinterestgroup.co.uk/ 

wpcontent/uploads/2020/07/Cost-of-Constipation-2020.pdf 

5. Kumar, L., Barker, C., Emmanuel, A. (2014). Opioid-Induced Constipation: Pathophysiology, Clinical 

Consequences, and Management, Gastroenterology Research and Practice. 2014. https://doi. 

org/10.1155/2014/141737

COMPANY NEWS 

STUDY CONFIRMS ACCURACY OF NEW GENERATION 

GASTROPANEL ® TEST FOR NON-INVASIVE DIAGNOSIS OF 

ATROPHIC GASTRITIS AND HELICOBACTER PYLORI INFECTION 

A clinical validation study conducted at Oulu University 

Hospital (OUH) has confirmed the high accuracy of BIOHIT 

Oyj’s new generation GastroPanel ® test for the diagnosis of 

atrophic gastritis (AG) and Helicobacter pylori (Hp) infection 

in patients referred for gastroscopy. 1 This unique blood test is 

designed for the first-line diagnosis of Hp infection and AG in 

patients with upper abdominal symptoms, such as dyspepsia 

and gastro-oesophageal reflux disease (GORD), before 

endoscopy. GastroPanel is also the only test on the market 

capable of monitoring the regulatory mechanism of acid 

output in the stomach. 

Hp infection, AG and high acid output are important risk factors 

for gastric and oesophageal cancers. The new generation (unified) 

GastroPanel test works on the same principle as the original 

GastroPanel ELISA test and is designed to harmonize the ELISA 

processing conditions of four biomarkers. This highly informative assay 

is therefore a cost-effective solution for population-based screening for 

the risk of gastric cancer in asymptomatic and symptomatic individuals, 

and its efficacy has already been confirmed by several studies in both 

high- and low-risk countries. 

This latest study evaluated the diagnostic accuracy of the new 

generation GastroPanel test for the diagnosis of both AG and Hp 

infection in patients referred for gastroscopy from Primary Care with 

different indications. Along with the previously published clinical 

validation studies, 2,3 this biopsy-confirmed study was designed to 

verify the diagnostic capabilities of the new generation GastroPanel 

test compared to the current gold standard (gastroscopy and biopsy 

analysis), and to demonstrate its performance was comparable to the 

original GastroPanel test. The positive results from this study also pave 

the way for BIOHIT’s new GastroPanel Quick Test (point of care test) 

which will be launched in Q1 2022. 

Dr. Olli-Pekka Koivurova, Principal Investigator of the study at OUH, 

commented: “A total of 522 patients referred for gastroscopy at the 

Gastro Centre, OUH, were consented and enrolled for this particular 

study. Blood was sampled for all patients using the GastroPanel test, 

along with performing quality-controlled gastroscopies with mucosal 

biopsies. The results confirmed that the new generation GastroPanel 

is a highly accurate test for the non-invasive diagnosis of AG and Hp 

infection in patients referred for diagnostic gastroscopies.” 

For more information visit www.biohithealthcare.co.uk/gastropanel. 

1. Koivurova O-P, et al. Serological biomarker panel in diagnosis of 

atrophic gastritis and Helicobacter pylori infection in gastroscopy 

referral patients. Clinical validation of the new generation GastroPanel ® 

test. Anticancer Res. 2021, 41, 5527-5537. 

2. Koivurova O-P, et al. Screening of the patients with autoimmune 

thyroid disease (AITD) and type 1 diabetes mellitus (DM1) for atrophic 

gastritis (AG) by serological biomarker testing (GastroPanel ® ). EC 

Gastroenterol. Digest. Syst, 2020, 7, 181-195. 

3. Mäki M, et al. Helicobacter pylori (Hp) IgG ELISA of the newgeneration 

GastroPanel ® is highly accurate in diagnosis of Hp- 

Infection in gastroscopy referral patients. Anticancer Res, 2020, 40, 

6387-6398. 

About BIOHIT Healthcare Ltd 

BIOHIT Healthcare Ltd (www.biohithealthcare.co.uk) is part of 

the Finnish public company, BIOHIT OYJ, which specialises in the 

development, manufacture and marketing of products and analysis 

systems for the early diagnosis and prevention of gastrointestinal 

diseases. The company’s many unique and patented diagnostic tests 

transform clinical practice and make screening, diagnosis and monitoring 

of gastrointestinal diseases efficient and cost effective. Non-invasive 

diagnostics are at the core of BIOHIT’s offering, making it the provider of 

choice for leading gastroenterologists and laboratory scientists worldwide. 


29

COMPANY NEWS 

SYMPROVE: 

Symprove is a patented water-based probiotic that delivers viable 

bacteria to the gastrointestinal tract, as evidenced by extensive 

in-vitro data utilising the Simulator of the Human Intestinal 

Microbial Ecosystem (SHIME ® ). 1-3 Independent research to date 

has been undertaken in collaboration with research partners 

including University College London and King’s College London. 

With existing randomised controlled trials including irritable 

bowel syndrome, inflammatory bowel disease and diverticular 

disease completed, 4-6 further studies underway with key 

research partners including Sheffield Hallam University, include 

diverticulitis and Parkinson’s disease. These studies are due for 

publication in 2022-2023. A full summary of Symprove published 

data is available at symproveforprofessionals.com. 

Dr Andrew Thillainayagam, consultant gastroenterologist, Imperial College 

Healthcare NHS Trust, London: “Behavioural disorders of the gut, what we 

call functional bowel disorders, of which IBS is one, have a terrible impact on 

people’s quality of life. I recommend Symprove to almost all of my patients 

who have functional problems in the gut, based on the enormous amount of 

clinical evidence behind it, which includes randomised controlled trials.” 

London: “Symprove is different 

from other probiotics because 

it is water-based, which means 

it limits exposure to gastric 

juices and digestive enzymes in 

the stomach. Symprove is also 

fermented, enabling the bacteria 

to grow and become used to 

an acidic environment as part of 

the manufacturing process. This 

means when a patient swallows 

Symprove, the bacteria are able to 

survive the stomach acid and then 

thrive in the colon.” 

Barry Smith, Founder of Symprove Ltd, says: “At Symprove, we pride 

ourselves on our loyal customer base, with 92% of people feeling the 

difference at 12 weeks in their Symprove journey. We are hugely excited 

about what the future holds, as we expand our research programme to 

support different patient groups.” 

Prof Simon Gaisford, Professor of Pharmaceutics, University College 

Find out more at symproveforprofessionals.com 

Refences 

1. Fredua-Agymean M, et al. Benef Microbes 2015;6(1):141–51. 

2. Ghyselinck J, et al. Int J Pharm X 2021:3:100087. 

3. Ghyselinck J, et al. Int J Pharm 2020;587:119648. 

4. Sisson G, et al. Aliment Pharmacol Ther 2014;40(1):51–62. 

5. Bjarnason I, et al. Inflammopharmacology 2019;27(3):465–473. 

6. Kvasnovsky CL, et al. Inflammopharmcology 2017; doi: 10.1007/s10787-017-0363-y. 

EVALUATE THE ENTIRE ANALYTICAL 

PROCESS OF THE BCID2 PANEL 

ASSAY FOR SEPSIS 


The BIOFIRE ® Blood Culture Identification 2 (BCID2) Panel 

rapidly detects pathogens and antimicrobial resistance genes, 

directly from positive blood cultures, to shorten the time to 

optimal therapy for sepsis. To monitor accuracy and precision 

of the whole system the new Streck MDx-Chex Control is 

the first-of-its-kind quality control, specifically designed to 

meet the standards for verifying the entire analytical process 

of the BioFire BCID2 sepsis assay. It provides confidence 

in instrument results to ensure the best patient treatment 

decisions. 

Now available in the UK from Alpha Laboratories, MDx-Chex 

evaluates the entire analytical process of the assay, including cell 

lysis, DNA extraction, purification and removal of PCR inhibitors, as 

well as qPCR amplification, detection and analysis. 

MDx-Chex contains 43 bacteria, yeasts and antimicrobial resistance 

gene targets covering all those tested on the BIOFIRE BCID2 Panel. The 

intact, inactivated microorganisms are suspended in a matrix of stabilized 

red and white blood cells, plus blood culture media components, designed 

to challenge the lysis and purification processes, just like a patient sample. 

Routine use of MDx-Chex for BCID2 as a full process quality control can help 

identify variations in the test system that can lead to incorrect results. It can be 

used as a 3rd party quality control to support ISO 15189 compliance. 

View the MDx-Chex for BCID2 Best Practice Guide at: 

https://www.youtube.com/watch?v=1z0g5DVtCEU 

Please visit www.alphalabs.co.uk for further information or contact 

Alpha Laboratories on 0800 38 77 32 or email 

marketing@alphalabs.co.uk 

30

COMPANY NEWS 

Thousands of 

healthcare professionals 

recommend Symprove 

Symprove is a live liquid-based probiotic 

containing four strains of bacteria* 

Evidence-based: Independent research conducted at 

University College London and King’s College London. 

Safety: Well tolerated, long history of safe use. 

All strains are fully characterised. 

Here are the reasons why: 

Survival: In vitro/in vivo research demonstrating 

viability of bacteria through the gut. 

Formulation: Manufactured to ensure 

bacterial tolerance through the gut. 

For more information please visit: symproveforprofessionals.com 


*Lacticaseibacillus rhamnosus NCIMB 30174, Enterococcus faecium NCIMB 30176, Lactobacillus acidophilus NCIMB 30175, Lactiplantibacillus plantarum NCIMB 30173. 

31

Helicobacter Test INFAI ® 

The most used 13 C-urea breath test for the 

diagnosis of Hp-infection worldwide 

• more than 4.5 million INFAI tests performed in Europe 

• approved for children from the ages of 3 to 11 

• special INFAI test for patients with dyspepsia taking PPIs 

• cost-effective CliniPac Basic version for hospital use 

INFAI Institute for Biomedical Analysis & NMR Imaging, INFAI UK Ltd 

Innovation Centre, University Science Park, University Road, Heslington, YORK YO10 5DG, UK 

Phone +44 1904 435 228 - Fax +44 1904 435 229 - mail: info@infai.co.uk - Visit us at www.infai.com

Gastroenterology Today Summer 2022

Create successful ePaper yourself

Delete template?

Save as template?